Health Insurance Claims Processor / Adjudication (Medicare) | Clearwater, FL

technologies, and streamline operations. With strong industry knowledge, we deliver value to our customers by providing compassionate customer service, efficient processing, and quality results. Here at IAS, we embrace the fact that great things are only accomplished by working as a team.

We believe that all of our employees have valuable input no matter the level. Our highly collaborative team environment offers each of our employees a place where they can excel. JOB SUMMARY: Work directly with an Underwriter to learn how to review an application for insurance coverage against a carrier's guidelines to determine eligibility. Candidate must be local. This is not a remote position, at

this time. ESSENTIAL DUTIES & RESPONSIBILITIES ( other duties may be assigned as necessary ): Must be able to work your scheduled shift and if needed, rotate schedules with other employees for proper departmental staffing needs, work overtime if needed and (including mandatory AEP overtime).

Must be detailed oriented and possess good verbal/written/typed communication skills. Must be able to work in a work environment where procedures change frequently. Must be able to work independently and efficiently to meet contractual time service agreements. Assist agents with comments or questions about applications and the likelihood of acceptance by the company. Using the main frame computer

system, log applications using automated log/proposal program, ensuring that agent is appointed in the state where the application was written, application was signed by both the agent and applicant, and the correct state-approved application and required miscellaneous forms are submitted and complete.

Calculate modal premium due, noting any shortage or overage, and prepare and balance CWA Input Form. Using the main frame computer system input CWA into the CWA database, when applicable. Make out going calls to agents or applicants to verify information that is left blank or unclear on the application. Complete non-medical telephone interviews with applicants when necessary.

Order and follow up on requirements pre and post issue. Learn and understand the differences between Federal and State Open Enrollment, Guarantee Issue and Standard applications. QUALIFICATIONS/SKILLS: High School Diploma/GED with one (1) year experience in insurance, the medical field or customer service. Language skills: ability to read and interpret documents such as procedure manuals and written handouts. Reasoning ability: need to apply common sense to carry out written and/or verbal instructions. Must be able to deal with problems containing multiple variables. Must be a team player, also multi-tasked, organized, and work efficiently.

Exhibit self-direction and proactive problem solving. Uses tact when expressing ideas or opinions to respond to objections successfully. Work in a timely manner to meet deadlines, while maintaining a high level of accuracy and quality. Calculate figures and amounts, with and without use of an adding machine. Must be able to type at least 40 wpm. Must have knowledge of Microsoft Word, Microsoft Outlook (email), and other computer systems. shop and/or insurance background is preferred. Honesty, as well as respect, for the company and its policies & procedures is crucial.

Benefits: Medical/Dental/Vision Benefits first of the month after hire date 401(k) Company matching and contributions are immediately vested 15 days PTO after 90 days Referral program 11 Paid Holidays Employee Assistance Program Tuition Reimbursement Schedule: Monday to Friday 37 hour work week IAS is an equal opportunity employer. Job Posted by Applicant Pro

technologies, and streamline operations. With strong industry knowledge, we deliver value to our customers by providing compassionate customer service, efficient processing, and quality results. Here at IAS, we embrace the fact that great things are only accomplished by working as a team.

We believe that all of our employees have valuable input no matter the level. Our highly collaborative team environment offers each of our employees a place where they can excel. JOB SUMMARY: Proofread documents and correct any errors (grammatical, typographical and/or compositional) in the computer system prior to printing policies. Resolve any discrepancies that arise; print policies, assemble and

mail policies. Candidate must be local. This is not a remote position, at this time. ESSENTIAL DUTIES & RESPONSIBILITIES (other duties may be assigned as necessary ): Must be able to work your scheduled shift and if needed, rotate schedules with other employees for proper departmental staffing needs and /or Work Overtime if needed.

Proof read submitted documents against information that was data entered into the computer system Make necessary corrections in the database. Ensure that cash with application for each policy agrees with required modal premiums or that the correct switch is marked appropriately for drafting purposes. Verify that status of policy has been properly dispositioned

in the database. Meet deadlines for month-end closing. Request and print policies for each approved application.

Assemble policies in the correct order, making sure all pages are present and correct (when necessary). Print policy schedule pages upon request from Underwriting or POS. Process reopened or released in error policies. Print requests for duplicate policies and re-mails. Input a mailing code in the system and document mailed policies daily. Provide assistance to other New Business areas, when needed. 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.

Language skills: ability to read and interpret documents such as procedure manuals and written handouts. Mathematical skills: ability to add, subtract, multiply and divide. Reasoning ability: need to apply common sense to carry out written and/or verbal instructions. Ability to deal with problems with multiple variables. Honesty, as well as respect, for the company and its policies & procedures is crucial EDUCATION and/or EXPERIENCE REQUIRED: High school diploma or equivalent. Six (6) months to one (1) year related experience or training preferred.

Medical insurance experience a plus. Computer experience a plus. Benefits: Medical/Dental/Vision Benefits first of the month after hire date 401(k) Company matching and contributions are immediately vested 15 days PTO after 90 days Referral program 11 Paid Holidays Employee Assistance Program Tuition Reimbursement Schedule: Monday to Friday 37 hour work week IAS is an equal opportunity employer. Job Posted by Applicant Pro

technologies, and streamline operations. With strong industry knowledge, we deliver value to our customers by providing compassionate customer service, efficient processing, and quality results. Here at IAS, we embrace the fact that great things are only accomplished by working as a team.

We believe that all of our employees have valuable input no matter the level. Our highlycollaborative team environment offers each of our employees a place where they can excel. JOB SUMMARY: Provide support for the New Business Department. Responsible for the assistance with various clerical duties in support of the department staff. Provide prompt and courteous customer service. Clear understanding

of how various functions within the operation relate to and impact each other. Comprehensive Customer Service Experience Needed - Fast Pace Environment - AWD Experience - Medicare Supplement a Plus Candidate must be local.

This is not a remote position, at this time. ESSENTIAL DUTIES & RESPONSIBILITIES (other duties may be assigned as necessary): Must be able to work scheduled shift and if needed, rotate schedules with other employees for proper departmental staffing needs and/or work Overtime as needed. Answering and documenting phone calls from a call center environment. Make outgoing calls to verify information with the applicant(s) or agent(s). Ability to type letters for amendments,

additional requirements, declines, not takens and problems. Process Check Requests for declines, not takens and overpayments.

Process and input additional CWA. Follow-up on application and agent problems. Calculate premium difference and rates using mathematical skills: ability to add, subtract, multiply and divide. In a workflow system, match facsimiles and mail received to the appropriate file. Follow-up on all pending requirements. Process applications with stop payments placed on the check. Process pending requirements when received and update the database. Generate follow-up letters on all problem applications. Must be able to work in an environment where procedures change frequently.

Understand Federal and State requirements for open enrollment, guarantee issue and underwritten applications. Update the database with all the appropriate information. Prep files by creating an image coverage sheet and separate each item with a separator sheet for the imaging department. EDUCATION and/or EXPERIENCE REQUIRED: High school diploma or equivalent. Computer experience required. Prior office experience preferred. Medical insurance experience a plus. BENEFITS: Medical/Dental/Vision Benefits first of the month after hire date 401(k) Company matching and contributions are immediately vested 15 days PTO after 90 days Referral program 11 Paid Holidays Employee Assistance Program Tuition Reimbursement SCHEDULE: Monday to Friday 37 hour work week IAS is an equal opportunity employer.

Job Posted by Applicant Pro

technologies, and streamline operations. With strong industry knowledge, we deliver value to our customers by providing compassionate customer service, efficient processing, and quality results. Here at IAS, we embrace the fact that great things are only accomplished by working as a team.

We believe that all of our employees have valuable input no matter the level. Our highly collaborative team environment offers each of our employees a place where they can excel. JOB SUMMARY: Responsible for the assistance with various clerical duties in support of the claims staff. Provide prompt and courteous customer service. Utilize applicable policy form, insurance law and internal procedures to

answer inquires and process requests for clients and department. Analyze claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines.

Clear understanding of how various functions with the operation relate to and impact each other. Candidate must be local. This is not a remote position, at this time. ESSENTIAL DUTIES & RESPONSIBILITIES : (Other duties may be assigned as necessary. ): Communicate effectively and professionally with providers, agents, policyholders and their representatives. Filing. Retrieving case files and updating/placing corresponding documents in appropriate case files. Prepare and

copy documentation and /or files for mailing to clients. Assist with daily file transfer between departments.

Send out monthly-standardized letters. Maintain the daily distribution of the mail and fax logs. Sort and distribute incoming mail. Provide training and or direction to new employee as applicable. Maintain billing log for vendors, and recognizing applicable deadlines for completion. Process ongoing case load and make decisions necessary to properly adjudicate those 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 claim processing.

Communicate effectively and professionally with providers, agents, policyholders and their representatives, and vendors. Interact and communicate professionally with manager, supervisor, and other departments. Maintain individual caseloads and internal reports for claim tracking purposes. OTHER FUNCTIONS: Coordinate tasks and schedules with team members for maximum team efficiency. Review, utilize and maintain procedure manuals. As needed miscellaneous duties/ projects as assigned by management. 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. Team centered with excellent work ethic and reliability required. Must possess excellent verbal and written communication skills. Ability to work independently and exhibit flexibility in performing multiple functions. Ability to operate office equipment. Good PC application skills a plus. Excellent telephone and customer service skills. Good attendance and work ethic. Must have excellent organizational and decision making skills Medical terminology and previous health/Medicare/Rx/Disability claims experience a plus.

Ability to calculate figures accurately. Clear understanding of the policy benefits and procedures with in the Claim unit. Must be able to manage time effectively with written correspondence, faxes, and referrals from other departments in order to comply with service guarantees. EDUCATION and/or EXPERIENCE REQUIRED: High School Diploma or GED equivalent. Prior claims processing, customer service, and clerical experience is preferred. Medical terminology and previous Long Term Care Claim processing experience is a plus.

Insurance, PC, Windows, Word and Excel experience is required. Benefits: Medical/Dental/Vision Benefits first of the month after hire date 401(k) Company matching and contributions are immediately vested 15 days PTO after 90 days Referral program 11 Paid Holidays Employee Assistance Program Tuition Reimbursement Schedule: Monday to Friday 37 hour work week IAS is an equal opportunity employer. Job Posted by Applicant Pro