Integrity Marketing Group LLC dezvoltă servicii de tehnologie și date pentru sectoarele asigurărilor și serviciilor financiare. Platforma sa omnicanal conectează asigurătorii cu consumatorii, agenții și consultanții în activitățile de marketing și distribuție, ajutând oamenii să acceseze produse de asigurare și financiare legate de protecția financiară și sănătate. Integrity îmbină tehnologia proprie, analiza datelor și parteneriatele pentru a susține această activitate. Compania se descrie ca fiind deținută de angajați și afirmă că apreciază familia, serviciul și practicile de afaceri etice.
Health Insurance Claims Adjuster
Adjudicate medical claims for Insurance Administrative Solutions, a third-party administrator serving insurance carriers. Interpret coverage, process claims, and flag potential fraud or waste.
Descriere
- Assess medical claims to determine the insurance carrier’s liability
- Apply contract benefits and claims processing guidelines
- Review, research, and decide claims and written inquiries for proper adjudication
- Organize and use daily information about benefits, coverage, and policy decisions
- Plan daily work around check cycles to meet service guarantees
- Identify and escalate potential fraud or waste
- Investigate and track suspect claims, recording findings accurately in clear system notes
- Connect business strategy to day-to-day claims processing
- Communicate with providers, agents, and policyholders
- Handle other assigned duties
Cerințe
- High school diploma or GED
- At least one year of demonstrated health insurance claims adjudication experience
- Insurance industry experience preferred
- Medical or prescription claims experience 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 explanations of benefits (EOBs) and claim histories
- Strong research skills
- Familiarity with Microsoft Office
- Qiclink software familiarity is a plus
- Ability to calculate deductibles and coinsurance
- Ability to adapt to different people and tasks
- Strong communication and documentation skills
- Ability to multitask, prioritize, and manage time effectively
- Reliable transportation
- Punctual and dependable
Beneficii
- Medical, dental, and vision insurance with 80% of premiums paid by the employer
- 401(k) retirement plan
- Paid holidays
- Paid time off
- Community service paid time off
- Flexible spending and health savings accounts (FSA/HSA)
- Life insurance
- Short-term and long-term disability coverage
- Competitive compensation package
- Professional opportunities for career advancement
- Reasonable accommodations for qualified individuals with disabilities