Health Insurance Claims Adjuster-2

Location: Clearwater, Florida, United States

Company

Independent distributor of life, health, and wealth insurance products with a strong insurtech focus and nationwide agent and client support.

What you will do

• Analyze, research, and adjudicate health insurance claims and written inquiries.
• Interpret contract benefits and policy coverage according to claims processing guidelines.
• Review claim histories, calculate deductibles and coinsurance, and make liability decisions.
• Identify and escalate potential fraud or waste; investigate cases and maintain complete system notes.
• Coordinate daily workflow with check-cycle requirements and service guarantees.
• Communicate with providers, agents, and policyholders while processing a broad range of claim types.

Requirements

• High school diploma or GED equivalent.
• Two to four years 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, conduct research, and document decisions accurately.
• Ability to calculate deductible and coinsurance amounts and manage multiple priorities effectively.
• Reliable transportation and dependable, punctual attendance in Clearwater, Florida.

Nice to have

• Insurance background, especially medical or prescription claims experience.
• Familiarity with medical terminology, procedures, and diagnosis codes.
• Familiarity with Qiclink software.
• Agent license without active appointments.

Culture & Benefits

• Family-like work environment focused on employee support.
• Professional development opportunities within a hyper-growth organization.
• Competitive compensation package and employee benefits.
• Equal opportunity employment and reasonable accommodations for qualified individuals with disabilities.