Full-Time

Health Insurance Claims Processor / Adjudication

Medicare

Confirmed live in the last 24 hours

Integrity

Integrity

501-1,000 employees

Fintech
Financial Services

Junior

Clearwater, FL, USA

Candidate must be local. This is not a remote position.

Category
Insurance
Finance & Banking
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 (CMS-1450) and HCFA/professional (CMS-1500) claims.
  • Familiarity with medical terminology, procedure and diagnosis codes preferred.
  • Familiarity with Qiclink software a plus.
  • Ability to calculate figures and co-insurance amounts.
  • Ability to read and interpret EOB's.
  • Ability to multitask, prioritize, problem-solve and effectively adapt to a fast-paced, 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.
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 day-to-day business functions of claims processing.
  • Minimal external contact with providers/agents/policyholders.

Company Stage

Growth Equity (Non-Venture Capital)

Total Funding

N/A

Headquarters

Oxford, Massachusetts

Founded

2006

Growth & Insights
Headcount

6 month growth

4%

1 year growth

22%

2 year growth

79%
Simplify Jobs

Simplify's Take

What believers are saying

  • Growing demand for personalized insurance products offers new market opportunities for Integrity.
  • Insurtech partnerships can enhance Integrity's technological capabilities and service delivery.
  • Expansion of telehealth services aligns with consumer demand for remote healthcare options.

What critics are saying

  • Over-reliance on acquisitions may lead to integration challenges and cultural clashes.
  • Ambitious toy drive goals could strain resources and risk reputational damage if unmet.
  • Rapid expansion could result in operational inefficiencies and dilution of company culture.

What makes Integrity unique

  • Integrity's focus on holistic solutions sets it apart in the insurance industry.
  • The company's commitment to community service enhances its brand reputation.
  • Strategic partnerships with diverse communities expand Integrity's market reach.

Help us improve and share your feedback! Did you find this helpful?