Health Insurance Claims Adjuster

Location: Clearwater, Florida, United States. The role begins fully onsite; hybrid work may be introduced as proficiency is demonstrated, depending on business needs and department practices.

Company

Insurance Administrative Solutions, an hirify.global company, provides third-party administration and business process outsourcing services for insurance carriers across the United States.

What you will do

• Analyze, research, and adjudicate medical claims and written inquiries.
• Interpret benefits, contract coverage, and policy decisions according to claims processing guidelines.
• Organize daily information about benefits and coverage and coordinate workflow with check cycle days.
• Identify and escalate potential fraud or waste; investigate, track, and report relevant claims accurately.
• Maintain clear system notes and communicate with providers, agents, and policyholders.
• Connect claims processing activities with broader business objectives and service guarantees.

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 history, research effectively, and calculate deductibles and co-insurance.
• Strong communication, documentation, multitasking, prioritization, and time-management skills.
• Reliable transportation and dependable punctuality.

Nice to have

• Insurance background, especially medical or prescription claims.
• Familiarity with medical terminology, procedures, diagnosis codes, and Microsoft Office products.
• Experience with Qiclink software.

Culture & Benefits

• Full-time employment with an initial onsite learning and team-integration period.
• Medical, dental, and vision insurance.
• 401(k) retirement plan and FSA/HSA options.
• Paid holidays, PTO, and community service PTO.
• Life insurance and short-term and long-term disability coverage.