Health Insurance Claims Adjuster

Health Insurance Claims Adjuster

Insurance Administrative Solutions, L.L.C. (“IAS”), an Integrity company headquartered in Clearwater, Florida, is a third‑party administrator providing business process outsourcing for insurance carriers.

Job Summary:

Analyze claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines.

• Examine, perform, research and make decisions necessary to properly adjudicate claims and written inquiries.
• Receive, organize and use daily information regarding benefits, contract coverage, and policy decisions.
• Interpret contract benefits in accordance with specific claim processing guidelines.
• Coordinate daily workflow to coincide with check cycle days to meet all service guarantees.
• Recognize red flags for potential fraud or waste, investigate, track via clear and complete system notes, and accurately report on each file/case in a timely manner.
• Understand broad strategic concept of the business and link these to day‑to‑day business functions of claims processing.
• Maintain external contact with providers, agents and policyholders.

• High school diploma or GED equivalent.
• Minimum 1 year proven health insurance claims adjudication experience.
• Insurance background preferred; previous medical/prescription claims preferred.
• Experience with UB/institutional (CMS‑1450) and HCFA/professional (CMS‑1500) claims required.
• Familiarity with medical terminology, procedures and diagnosis codes preferred.
• Ability to read and interpret EOB claim history and excellent research skills.
• Familiarity with Microsoft Office and Qiclink software a plus.
• Ability to calculate deductible and co‑insurance amounts.
• Ability to adapt and respond to different types of people and tasks.
• Excellent communication, documentation and time‑management skills.
• Reliable transportation and punctuality.

• Medical/Dental/Vision Insurance
• 401(k) retirement plan
• Paid holidays, PTO and community service PTO
• FSA/HSA, life insurance, short‑term & long‑term disability

Integrity, LLC is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability, veteran status or any other characteristic protected by federal, state or local law. In addition, Integrity, LLC will provide reasonable accommodations for qualified individuals with disabilities.