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Integrity Marketing Group LLCCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in claims adjudication, including the ability to analyze claims, interpret contract benefits, and maintain effective communication with various stakeholders. Proficient in utilizing claims processing guidelines and software to ensure compliance with service guarantees.
Highest-signal resume keywords
Claims Adjudication ExperienceMedical Terminology FamiliarityQiclink Software ProficiencyOrganizational SkillsDecision Making Skills
About the role
Key responsibilities & impact- Analyze claims to determine the extent of insurance carrier liability
- Interpret contract benefits according to claims processing guidelines
- Receive, organize, and use information regarding benefits, contract coverage, and policy decisions
- Coordinate daily workflow with check cycle days to meet service guarantees
- Maintain external contacts with policyholders, providers, agents, attorneys, and other carriers
- Maintain internal contacts with peers, management, and support areas
- Examine, perform, research, and make decisions to properly adjudicate claims and written inquiries
- Understand broad strategic business concepts and link them to day-to-day claims processing
- Maintain minimal external contact with providers, agents, and policyholders
Requirements
What you’ll need- Candidate must be local
- High School diploma or GED equivalent
- Minimum of one (1) year related experience 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
- Experience in medical/insurance preferred
- Experience with Medicare Supplement preferred
Benefits
Comp & perks- 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
- Competitive compensation package
- Reasonable accommodations for qualified individuals with disabilities
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AnalysisContract InterpretationTyping Skills (30 WPM)EOB InterpretationCo-Insurance CalculationUB Claims ExperienceHCFA Claims ExperiencePolicy Benefits UnderstandingClaims Processing GuidelinesResearch and Decision Making
Soft Skills
Oral Communication SkillsWritten Communication SkillsTeam CollaborationReliabilityAdaptability
Tools & Technologies
Qiclink Software
Industry Keywords
Health InsuranceMedicarePrescription ClaimsMedical ClaimsInsurance Policies