Health Insurance Claims Adjuster

Join a dynamic team with a great client of ours, a leading health services provider in Pinellas County. Our client is committed to delivering top-notch service to their clients and needs a new member of the staff to help with that goal! We are seeking a detail-oriented and experienced Health Insurance Claims Adjuster to ensure fair and accurate claims evaluations. If you have a keen eye for detail, excellent investigative skills, and a strong understanding of health insurance policies, we want to hear from you!Key Responsibilities:- Investigate and evaluate health insurance claims to ensure accuracy and compliance with policy terms.- Assess the validity of claims by gathering and analyzing relevant information, including medical records, policy documents, and claimant statements.- Collaborate with policyholders, healthcare providers, and internal departments to resolve discrepancies and clarify policy terms.- Make informed decisions regarding claim approvals, denials, or adjustments based on policy guidelines and regulations.- Respond to complaints and inquiries from policyholders, providing clear explanations and resolutions.- Maintain detailed records of claims investigations, decisions, and communications.- Stay up-to-date with industry regulations, policy changes, and best practices to ensure compliance and efficiency in claims processing.Qualifications:- Minimum of 3 years of experience as a Health Insurance Claims Adjuster or in a similar role.- High school diploma or equivalent; additional certification in insurance or healthcare is a plus.- Strong understanding of health insurance policies, claims processing, and relevant regulations.- Excellent investigative and analytical skills, attention to detail, and ability to work with sensitive and confidential information.- Strong verbal and written communication skills to effectively interact with claimants, healthcare providers, and internal teams.- Ability to handle complex claims and complaints with a focus on fair and efficient resolution.-Previous administrative skills, can handle data entry, processing claims, activate services and create service ordersCompensation / Pay Rate (Up to): $24.00