Health Insurance Claims Adjuster

Location: Clearwater, Florida, United States. The role begins fully onsite, with hybrid work opportunities introduced as proficiency is demonstrated and depending on business needs.

Company

hirify.global is an independent distributor of life, health, and wealth insurance products with a strong insurtech focus; Insurance Administrative Solutions provides third-party administration and business process outsourcing for insurance carriers.

What you will do

• Analyze, research, and adjudicate medical claims and written inquiries.
• Interpret benefits, contract coverage, policy decisions, and claim-processing guidelines.
• Coordinate daily claims workflows around check cycles and service guarantees.
• Identify and escalate potential fraud or waste, investigating cases and maintaining complete system notes.
• Maintain external communication with providers, agents, and policyholders.

Requirements

• High school diploma or GED equivalent.
• At least one year of health insurance claims adjudication experience.
• Experience with UB/institutional CMS-1450 and HCFA/professional CMS-1500 claims.
• Ability to read and interpret EOBs and claim histories, calculate deductibles and coinsurance, and conduct detailed research.
• Strong communication, documentation, multitasking, prioritization, and time-management skills.
• Reliable transportation and punctual, dependable attendance are required.

Nice to have

• Medical or prescription claims experience.
• Familiarity with medical terminology, procedures, and diagnosis codes.
• Experience with Microsoft Office and Qiclink software.

Culture & Benefits

• Hybrid work opportunities may become available after the initial onsite learning and integration period.
• Medical, dental, and vision insurance with 80% employer-paid coverage.
• 401(k) retirement plan, paid holidays, PTO, and community service PTO.
• FSA/HSA, life insurance, and short-term and long-term disability coverage.
• Family-oriented environment with professional growth opportunities.