Health Insurance Claims Processor Adjudication Medicare

About Insurance Administrative Solutions
Insurance Administrative Solutions (IAS) is a thirdparty provider of comprehensive administrative solutions for our clients in the insurance industry. We offer a business process outsourcing solution that helps insurers optimize administrative workload bolster their industry expertise leverage emerging technologies and streamline operations. With strong industry knowledge we deliver value to our customers by providing compassionate customer service efficient processing and quality results. Here at IAS we embrace the fact that great things are only accomplished by working as a team. We believe that all of our employees have valuable input no matter the level. Our highly collaborative team environment offers each of our employees a place where they can excel.

Job Summary

Analyze claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines. Receive organize and make daily use of information regarding benefits contract coverage and policy decisions. Coordinate daily workflow to coincide with check cycle days to meet all service guarantees. Maintain external contacts with policyholders providers of service agents attorneys and other carriers as well as internal contacts with peers management and other support areas with a positive and professional approach. Candidate must be local. This is not a remote position at this time

Primary Responsibilities:

• Examine/perform/research & make decisions necessary to properly adjudicate claims and written inquiries.
• Interpret contract benefits in accordance with specific claim processing guidelines.
• Understand broad strategic concept of our business and link these to the daytoday business functions of claims processing.
• Minimal external contact with providers/agents/policyholders.

Primary Skills & Requirements:

• Good oral and written communication skills
• Good PC application skills and typing to 30 wpm with accuracy and clarity of content.
• Previous health/Medicare/prescription claims adjudication experience a plus.
• Must have organizational and decision making skills.
• Team centered with excellent work ethic and reliability.
• Experience with UB/institutional (CMS1450 and HCFA/professional (CMS1500 claims.
• Familiarity with medical terminology procedure and diagnosis codes preferred.
• Familiarity with Qiclink software a plus.
• Ability to calculate figures and coinsurance amounts.
• Ability to read and interpret EOBs.
• Ability to multitask prioritize problemsolve and effectively adapt to a fastpaced changing environment in order to comply with service guarantees.
• Must be able to work independently and meet quality and production standards.
• Must have clear understanding of the policy benefits and procedures within the Claims unit.
• Honesty as well as respect for the company and its policies & procedures is crucial.
• High School diploma or GED equivalent.
• Minimum of one 1 year related experience required.
• Experience in medical/insurance preferred.
• Experience with Medicare Supplement preferred.

Schedule:

• Monday to Friday
• 37 hour work week

#IntegrityStrong

About Integrity

Integrity is one of the nations leading independent distributors of life health and wealth insurance products. With a strong insurtech focus we embrace a broad and innovative approach to serving agents and clients alike. Integrity is driven by a singular purpose: to help people protect their life health and wealth so they can prepare for the good days ahead.

Integrity offers you the opportunity to start a career in a familylike environment that is rewarding and cutting edge. Why Because we put our people first! At Integrity you can start a new career path at company youll love and well love you back. Were proud of the work we do and the culture weve built where we celebrate your hard work and support you daily. Joining us means being part of a hypergrowth company with tons of professional opportunities for you to accelerate your career. Integrity offers our people a competitive compensation package including benefits that make work more fun and give you and your family peace of mind.

Headquartered in Dallas Texas Integrity is committed to meeting Americans wherever they are in person over the phone or online. Integritys employees support hundreds of thousands of independent agents who serve the needs of millions of clients nationwide. For more information visit Integrity.

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.