Insurance Administrative Solutions
  • 12-Nov-2020 to 30-Nov-2021 (EST)
  • Clearwater, FL, USA
  • Hourly
  • Full Time

Medical - Dental - Vision - 401K - Basic and Supplemental Life Insurance - Long and Short Term Disability


JOB SUMMARY: Examine, perform, research, and make decisions necessary to resolve credit balances, or returned checks from providers or policyholders due to Medicare adjustments, & overpayments, received daily.  Information may be fund posted, adjusted, voided, and will include balancing member's history files on the processing system.  Must possess the ability to process and reissue correct payment to the correct entity.  Must interpret contract benefits in accordance with specific claims processing guidelines.  Communicate problems identified relevant to the claims processing system to the appropriate people.  May require 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):

  • Research and resolve overpayments on refunds received daily.
  • Post, adjust and balance member's history on claims systems.
  • Research and gather information for the auditor involving quality errors.
  • Post stop payments made on policyholders account, received by the Accounting Dept., and reissue payments correctly.
  • Handle all transmittal reports or inquiries received from client office, researching and resolving matters.
  • Responsible for researching and documenting all reports received by the Accounting Dept. for unclaimed property including researching, posting voids onto the system and reissue to the necessary party.
  • Balance weekly / bi-weekly check register on all transactions and adjustments made onto QicLink.
  • Post archived records and adjustments in fund posting.
  • Answer calls as required by company policy in a helpful, professional, timely manner.
  • Place outgoing calls to provide or obtain information.
  • Document all calls, and research in the system, while in progress.  On-line call documentation program should be used when available.
  • Actively participate in cross training to maximize team efficiency and maintain or exceed service standards.
  • Communicate openly with Supervisor and other team members to ensure accurate responses and to avoid duplication of efforts.
  • Must understand the broad strategic concept of our business and link these to the day-to-day business functions of customer service and claim processing.

 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. 

  • Ability to read and interpret EOB's, claim history, and excellent research skills are required.
  • Must have a clear understanding of the policy benefits and procedures within the claims and customer service unit.
  • Knowledge of claims processing preferred.
  • Good interpersonal and decision-making skills required.
  • Good written and oral communication skills with the ability to speak effectively and clearly over the phone.
  • Must be organized and able to manage time effectively with checks, accounting reports, check register, fund posting, and any related information from or to other departments in order to comply with service guarantees.
  • Good PC application skills and typing to 30 wpm with accuracy and clarity of content.
  • Attention to detail and ability to listen / type simultaneously.
  • Must be able to exhibit flexibility in performing multiple functions.
  • Excellent attendance and work ethic.
  • Team centered.
  • Honesty and respect for the company and its policies and procedures is required.

 EDUCATION and/or EXPERIENCE REQUIRED:

  • Associate's degree (AA) or equivalent from two-year college or technical school, or six months to one year related experience and/or training; or equivalent combination of education and experience.
  • Medical terminology and basic knowledge of claims processing a plus.
  • Insurance background experience preferred.
  • PC/Windows experience needed.

IAS is an equal opportunity employer

Insurance Administrative Solutions
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IAS is an Equal Opportunity Employer

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