Insurance Claims Adjuster
Company: Frankcrum Staffing
Location: Clearwater
Posted on: May 17, 2024
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Job Description:
Claims Adjuster 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. ESSENTIAL DUTIES &
RESPONSIBILITIES (other duties may be assigned as necessary):
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.
QUALIFICATIONS: To perform this job successfully, an individual
must be able to perform each essential duty satisfactorily. The
requirements listed below are representative of the knowledge,
skill, and/or ability required. 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. EDUCATION
and/or EXPERIENCE REQUIRED: High School diploma or GED equivalent.
Minimum of one (1) year related experience required. Experience in
medical/insurance preferred. Experience with Medicare Supplement
preferred. #talrooclearwater Associated topics: adjuster, auto,
automobile, casualty, claim, damage, fraud, insurance examiner,
investigate, title examiner
Keywords: Frankcrum Staffing, Greater Carrollwood , Insurance Claims Adjuster, Other , Clearwater, Florida
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