Jobs

    Claims Adjuster II - Clearwater, United States - FrankCrum Staffing, Inc.

    FrankCrum Staffing, Inc.
    FrankCrum Staffing, Inc. Clearwater, United States

    2 weeks ago

    Default job background
    Description

    Job Description

    Job DescriptionClaims Adjuster


    II JOB SUMMARY:
    Analyze claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines. Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions. Coordinate daily workflow to coincide with check cycle days to meet all service guarantees.

    Maintain 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):
    Examine/perform/research & make decisions necessary to properly adjudicate 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 claims processing.

    In addition to being able to handle the initial claims that they were trained on, they will be able to handle the majority of claim types within the department .

    Minimal external contact with providers/agents/policyholders.


    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.

    Good oral and written communication skills Good PC application skills and typing to 30 wpm with accuracy and clarity of content.

    Previous health/Medicare/prescription claims adjudication experience a plus. Must have organizational and decision making skills. Team centered with excellent work ethic and reliability. Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims. Familiarity with medical terminology, procedure and diagnosis codes preferred. Familiarity with Qiclink software a plus. Ability to calculate figures and co-insurance amounts. Ability to read and interpret EOB's.

    Ability to multitask, prioritize, problem-solve and effectively adapt to a fast-paced, changing environment in order to comply with service guarantees.

    Must be able to work independently and meet quality and production standards. Must have clear understanding of the policy benefits and procedures within the Claims unit. Honesty, as well as respect, for the company and its policies & procedures is crucial.


    EDUCATION and/or EXPERIENCE REQUIRED:
    High School diploma or GED equivalent. Minimum of one (1) year related experience required. Experience in medical/insurance preferred. Experience with Medicare Supplement preferred. #talrooclearwater
  • PrideStaff

    Claims Adjuster

    3 weeks ago

    PrideStaff Clearwater, United States

    We have a great opportunity for individuals with medical coding and medical insurance experiences We have full time, first shift claims adjuster roles with a great company in Largo This client does offer PTO and insurance when you are hired into the company. · Duties: · Work wi ...

  • FrankCrum Staffing, Inc.

    Claims Adjuster

    2 weeks ago

    FrankCrum Staffing, Inc. Clearwater, United States

    Job Description · Job DescriptionWe are looking for Medical Claim Adjusters to join Our Team at Clearwater's leading provider of Comprehensive Administrative Services for the insurance industry. · ABOUT YOUYou'll spend your day analyzing claims to determine the extent of insuran ...

  • FrankCrum Staffing, Inc.

    Claims Adjuster

    2 weeks ago

    FrankCrum Staffing, Inc. Clearwater, United States

    Job Description · Job DescriptionWe are looking for Claim Adjusters to join Our Team at Clearwater's leading provider of Comprehensive Administrative Services for the insurance industry. · ABOUT YOUYou'll spend your day analyzing claims to determine the extent of insurance carri ...

  • Pridestaff

    Senior Claims Adjuster

    3 weeks ago

    Pridestaff Clearwater, United States

    Job Description · Job DescriptionWe have a great opportunity for individuals with medical coding and medical insurance experiences We have full time, first shift claims adjuster roles with a great company in Largo This client does offer PTO and insurance when you are hired into t ...

  • FrankCrum Staffing, Inc.

    Medical Claims Adjuster

    13 hours ago

    FrankCrum Staffing, Inc. Clearwater, United States

    Job Description · Job DescriptionWe are looking for Medical Claim Adjusters to join Our Team at Clearwater's leading provider of Comprehensive Administrative Services for the insurance industry. · ABOUT YOUYou'll spend your day analyzing claims to determine the extent of insuran ...

  • PrideStaff

    Senior Claims Adjuster

    2 weeks ago

    PrideStaff Clearwater, United States

    Job Description · Job Description · We have a great opportunity for individuals with medical coding and medical insurance experiences We have full time, first shift claims adjuster roles with a great company in Largo This client does offer PTO and insurance when you are hired i ...

  • PrideStaff

    Senior Claims Adjuster

    3 weeks ago

    PrideStaff Clearwater, United States

    We have a great opportunity for individuals with medical coding and medical insurance experiences We have full time, first shift claims adjuster roles with a great company in Largo This client does offer PTO and insurance when you are hired into the company. · In this role we ar ...

  • Bankers Financial Corp

    Sr. Inside Claims Adjuster

    15 hours ago

    Bankers Financial Corp Saint Petersburg, United States

    Job Description · Job DescriptionBankers Financial Corporation is a holding company that started in St. Petersburg, FL, in 1976. The heart of our corporation lies with our employees and our communities. At Bankers, we focus on building an environment where all voices are heard an ...

  • FrankCrum Staffing, Inc.

    Claims Adjuster I

    2 weeks ago

    FrankCrum Staffing, Inc. Clearwater, United States

    Job Description · Job DescriptionClaims Adjuster JOB SUMMARY: Analyze claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines. Receive, organize and make daily use of information regarding ...

  • Work At Home Vintage Experts

    Property & Casualty Claims Representative - Broker/Retail Agency - REMOTE

    1 week ago

    Work At Home Vintage Experts St. Petersburg, United States

    Put your Insurance Experience to work – FROM HOME · At WAHVE, we value significant insurance experience and want to revolutionize the way people think about phasing into retirement by offering qualified candidates the opportunity to continue their career working from home. As we ...

  • City of Treasure Island, FL

    Mechanic

    2 weeks ago

    City of Treasure Island, FL St. Petersburg, United States

    Salary: $ $27.92 Hourly · Location : Treasure Island · Job Type: Full-Time · Job Number: · Department: Public Works · Opening Date: 05/15/2024 · Closing Date: 6/7/2024 11:59 PM Eastern · FLSA: Non-Exempt · General Description · This is skilled work in the mechanical repai ...

  • FrankCrum

    Workers' Compensation Claims Processor

    1 week ago

    FrankCrum Clearwater, United States

    FrankCrum is a Top Workplace · FrankCrum, voted by its employees as a Top Workplace in Tampa Bay for more than 10 years in a row, is a Professional Employer Organization (PEO) based in Clearwater, Florida. FrankCrum employs approximately 500 people who serve over 4,000 businesse ...

  • CCS Medical

    Revenue Cycle Specialist

    3 days ago

    CCS Medical Clearwater, United States

    Are you looking for a purposeful career that will make a difference in the patient community? At CCS, our approach to at-home patient care is redefining chronic care management. We are seeking individuals that will thrive in a patient-centric dynamic environment. If you are an at ...

  • Deputy Assistant Secretary for Office of Resolution Management

    Equal Employment Specialist

    19 minutes ago

    Deputy Assistant Secretary for Office of Resolution Management St Petersburg, United States

    Summary · As an Equal Employment Specialist (Counselor) you will provide information on the Federal EEO complaint process to employees, applicants, managers, and serviced activities of ORMDI. Advising the aggrieved person about the EEO complaints process following the Equal Empl ...

  • CLevelCrossing

    Chief Risk Officer

    5 days ago

    CLevelCrossing Clearwater, United States

    Chief Risk Officer','234539','*Click Here for Detailed Leadership Profile. · At BayCare, we are proud to be one of the largest employers and a Top Workplace in the Tampa Bay area. Our network currently consists of 16 community-based hospitals, a long-term acute care facility, ho ...

  • DL Group, LLC

    First Party Property Litigation Attorney

    1 day ago

    DL Group, LLC Saint Petersburg, United States

    Job Description · Job DescriptionDistinguished, mid-sized NATIONAL insurance defense litigation firm is looking for experienced FLORIDA First Party Property Litigation Attorneys (First Party Property DEFENSE experience REQUIRED) to join their TAMPA team. · WE ALLOW HYBRID WORK-FR ...

  • U.S. Coast Guard

    Secretary, GS-0318-07

    2 weeks ago

    U.S. Coast Guard Clearwater, United States

    Summary · This position is located in Department of Homeland Security/U.S. Coast Guard, Lantarea CGD Seven (D7), Seventh Coast Guard District, Air Station Clearwater, Administration, Clearwater, FL. · This job is open toIndividuals with disabilities · Federal employees - Competit ...

  • Wallace Welch & Willingham

    Producer

    1 day ago

    Wallace Welch & Willingham St Petersburg, United States

    We are W3, an independent insurance agency founded in 1925. We have a rich history of providing quality service and unwavering commitment to our clients and community. In order to provide the best coverage at the most affordable rates, we represent an extensive list of "A rated" ...

  • City of Treasure Island, FL

    Crew Chief

    20 hours ago

    City of Treasure Island, FL St Petersburg, United States

    Salary: $ $32.31 HourlyLocation : Treasure IslandJob Type: Full-TimeJob Number: Department: Public WorksDivision: SanitationOpening Date: 06/05/2024Closing Date: 6/26/2024 4:59 PM EasternFLSA: Non-ExemptGeneral DescriptionThis is a highly responsible supervisory oversight positio ...

  • MyFlorida

    registered nurse supervisor

    3 weeks ago

    MyFlorida , FL, United States

    REGISTERED NURSE SUPERVISOR · Date: May 9, 2024 · Location: · MACCLENNY, FL, US, 32063 · The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website \_operations/human\_resource\_management/for\_job\_applicants/e\_verify) . · Requisi ...