Claims Examiner - Miami Springs
3 days ago

Job Summary
We are seeking a Claims Examiner to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.About the Role:
The Claims Examiner plays a critical role in the health care and social assistance industry by thoroughly reviewing and evaluating insurance claims to ensure accuracy, compliance, and appropriateness of payments. This position involves analyzing medical documentation ,policy details,and billing information to determine the validity of claims and identify any discrepancies or potential fraud.
Responsibilities
- Reviewand analyzehealthinsuranceclaimsforcompletenessaccuracyandcompliancewithpolicytermsandregulatoryrequirements.
- Verifymedicalcodes,treatmentdocumentation,andbillinginformationtosurenservicessareproperlycoveredandedited.
Job description
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