Claims Analyst jobs in Clearwater, FL

Integrity is one of the nation’s leading independent distributors of life, health and wealth insurance products. With a strong insurtech focus, we embrace a broad and innovative approach to serving agents and clients alike. Integrity is driven by a singular purpose: to help people protect their health and wealth so they can be ready for the good days ahead.

Headquartered in Dallas, Texas, Integrity is committed to meeting Americans wherever they are — in person, over the phone or online. Integrity’s employees support hundreds of thousands of independent agents who serve the needs of millions of clients nationwide. For more information, visit IntegrityMarketing.com.

ABOUT INSURANCE ADMINISTRATIVE SOLUTIONS

Insurance Administrative Solutions (IAS) is a third-party provider of comprehensive administrative solutions for our clients in the insurance industry. We offer a business process outsourcing solution that helps insurers optimize administrative workload, bolster their industry expertise, leverage emerging 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: Claims System Support is responsible for maintaining our claim processing system, testing and documenting any changes or additions, monitoring and validating adjuster usage through reports, importing and tracking electronic data into our claim directories. They must have a clear understanding of how the various functions within the claims department, as well as other areas, relate to and impact each other. They must be able to examine, perform research, and make decisions necessary to resolve and maintain eligibility and claims in general, for all our clients. They may assist with some questions regarding check runs on designated days, for each client, as necessary. They must be able to interpret contract benefits in accordance with specific claims processing guidelines and be able to communicate problems identified relevant to the claims processing system, to the appropriate people. May require external contact 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. Must work with little direction, and be able to identify all employees whose efforts must be included to achieve company goals. Must work well independently and be able to meet deadlines and prioritize workload daily.

Candidate must be local. This is not a remote position, at this time.

ESSENTIAL DUTIES & RESPONSIBILITIES (other duties may be assigned as necessary):

• Serve as liaison to the operational units for production problems and initiating new project requests (includes managing emails, troubleshooting, and participating in prioritization meetings)
• Research, evaluate, and analyze data and work flow processes to develop business requirements and / or present recommendations on process improvement and new project requests, while adhering to the principles of our system development project guidelines
• Coordinate and facilitate meetings across multiple departments to ensure business and user requirements, develop test scenarios, acquire user approvals, and ensure training notifications have been met
• Coordinate and facilitate walk through meetings with members of the claims team to ensure all parties understand the business needs and discuss potential solutions, timeframes, and any project or claim system dependencies
• Lead coordination efforts to make sure all clams tasks are completed when implementing new clients
• Work independently with minimal guidance from Manager / Director
• Accept and manage changing priorities and address issues swiftly and professionally
• Act in accordance with established IAS Standard Operating Procedures and maintain confidential information
• Update plan parameters and yearly deductible and co-insurance changes, and remark code updates (including CARCS/RARCS) in claims system.
• Establish and / or maintain adjuster codes and processing controls for each adjuster in claim system as well as all external service vendors when applicable.
• Run and monitor all reports including month end audit reports to identify and confirm program access.
• Handle all HIPAA ANSI files which includes 270/271, 276/277, 834, 835, and 837.
• Bring EDI claim files into the processing system daily and monitor auto adjudication.
• Work with and maintain professional communication with electronic payment service vendors.
• Monitor all claim files received, and notify appropriate personnel if files have not been received.
• Monitor bimonthly eligibility file sent to BCRC, and notify Administrator if problems arise.
• Balance carrier invoices to actual claims received.
• Document all calls, and research in the system, while in progress. On-line call documentation program / application should be used when available.
• 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.
• Provide new ideas for system enhancements to streamline claims operation.
• Provide design input for automated work flow system to ensure proper and affective distribution of work.

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.

• Excellent research and documentation skills are required.
• Must have a clear understanding of the policy benefits and procedures within the claims operations area.
• Previous health/Medicare/prescription claims adjudication experience a plus.
• 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 for any related information from or to other departments in order to comply with company service level requirements.
• 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 Health claims processing a must. Knowledge of EDI files for 270/271, 276/277, 834, 835/837 is a plus. Knowledge of QicLink a plus. Insurance background preferred. PC/Windows experience needed.

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

Integrity offers you the opportunity to start a career in a family-like environment that is rewarding and cutting edge. Why? Because we put our people first! At Integrity, you can start a new career path at company you’ll love, and we’ll love you back. We’re proud of the work we do and the culture we’ve built, where we celebrate your hard work and support you daily.

Joining us means being part of a hyper-growth company with tons of professional opportunities for you to accelerate your career. Integrity offers our people a competitive compensation package, including benefits that make work more fun and give you and your family peace of mind.

Integrity Marketing Group, LLC is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability, veteran status, or any other characteristic protected by federal, state, or local law. In addition, Integrity Marketing Group, LLC will provide reasonable accommodations for qualified individuals with disabilities