Best Doctors Insurance
Claims Adjudicator
Best Doctors Insurance - Miami, Florida, us, 33222
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Claims Adjudicator
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Best Doctors Insurance 1 week ago Be among the first 25 applicants Join to apply for the
Claims Adjudicator
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Best Doctors Insurance Position Purpose
Effectively and accurately applies policy conditions of coverage, processing guidelines and cost containment knowledge into the adjudication of global health claims and comprehensive cases. Processes all types of global health insurance claims Conduct claims analysis reviewing in detail claim documentation, medical reports and supporting documentation to decide compensability Examine with accuracy policy and member information, plan conditions of coverage and processing guidelines against claim documentation to determine benefit application Conduct post claim underwriting reviews to identify possible pre-existing condition Utilize anti-fraud policies to mitigate fraud possibility for submitted claims Review benefit letter / medical authorizations for cost and benefit application Evaluate claim compensability based on procedures performed, treatment intensity and diagnosis Validate benefit accumulators, patient responsibility, duplicate claim prevention and provider discount Assign ICD-10 codes along with valid procedure codes when necessary Apply Usual, Customary and Reasonable pricing guidelines to determine acceptable claim cost Maintain acceptable productivity and turnaround times for all assignments Maintain high work accuracy and quality scores Support team with versatile assignments related to department needs
Position Purpose
Effectively and accurately applies policy conditions of coverage, processing guidelines and cost containment knowledge into the adjudication of global health claims and comprehensive cases.
Essential Job Duties And Responsibilities
Processes all types of global health insurance claims Conduct claims analysis reviewing in detail claim documentation, medical reports and supporting documentation to decide compensability Examine with accuracy policy and member information, plan conditions of coverage and processing guidelines against claim documentation to determine benefit application Conduct post claim underwriting reviews to identify possible pre-existing condition Utilize anti-fraud policies to mitigate fraud possibility for submitted claims Review benefit letter / medical authorizations for cost and benefit application Evaluate claim compensability based on procedures performed, treatment intensity and diagnosis Validate benefit accumulators, patient responsibility, duplicate claim prevention and provider discount Assign ICD-10 codes along with valid procedure codes when necessary Apply Usual, Customary and Reasonable pricing guidelines to determine acceptable claim cost Maintain acceptable productivity and turnaround times for all assignments Maintain high work accuracy and quality scores Support team with versatile assignments related to department needs
Desired Minimum Qualifications
Proficiency in Microsoft product suite (i.e. Microsoft Office, Word, Excel, etc.) Strong analytical, problem solving and negotiating skills Ability to adapt quickly in fast paced environment Detail oriented with exceptional organizational and communication skills Complete Fluency in English, Spanish (Portuguese a plus) Proven ability to work independently and meet determined deadlines Ability to navigate and enter data utilizing multiple systems and screens
Education And Experience
Associates Degree or commensurate work experience Billing/Coding Certification preferred Minimum of 3 years experience in Health Insurance Industry Seniority level
Seniority level Mid-Senior level Employment type
Employment type Other Job function
Job function Finance and Sales Industries Insurance Referrals increase your chances of interviewing at Best Doctors Insurance by 2x Sign in to set job alerts for “Claims Adjuster” roles.
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Claims Adjudicator
role at
Best Doctors Insurance 1 week ago Be among the first 25 applicants Join to apply for the
Claims Adjudicator
role at
Best Doctors Insurance Position Purpose
Effectively and accurately applies policy conditions of coverage, processing guidelines and cost containment knowledge into the adjudication of global health claims and comprehensive cases. Processes all types of global health insurance claims Conduct claims analysis reviewing in detail claim documentation, medical reports and supporting documentation to decide compensability Examine with accuracy policy and member information, plan conditions of coverage and processing guidelines against claim documentation to determine benefit application Conduct post claim underwriting reviews to identify possible pre-existing condition Utilize anti-fraud policies to mitigate fraud possibility for submitted claims Review benefit letter / medical authorizations for cost and benefit application Evaluate claim compensability based on procedures performed, treatment intensity and diagnosis Validate benefit accumulators, patient responsibility, duplicate claim prevention and provider discount Assign ICD-10 codes along with valid procedure codes when necessary Apply Usual, Customary and Reasonable pricing guidelines to determine acceptable claim cost Maintain acceptable productivity and turnaround times for all assignments Maintain high work accuracy and quality scores Support team with versatile assignments related to department needs
Position Purpose
Effectively and accurately applies policy conditions of coverage, processing guidelines and cost containment knowledge into the adjudication of global health claims and comprehensive cases.
Essential Job Duties And Responsibilities
Processes all types of global health insurance claims Conduct claims analysis reviewing in detail claim documentation, medical reports and supporting documentation to decide compensability Examine with accuracy policy and member information, plan conditions of coverage and processing guidelines against claim documentation to determine benefit application Conduct post claim underwriting reviews to identify possible pre-existing condition Utilize anti-fraud policies to mitigate fraud possibility for submitted claims Review benefit letter / medical authorizations for cost and benefit application Evaluate claim compensability based on procedures performed, treatment intensity and diagnosis Validate benefit accumulators, patient responsibility, duplicate claim prevention and provider discount Assign ICD-10 codes along with valid procedure codes when necessary Apply Usual, Customary and Reasonable pricing guidelines to determine acceptable claim cost Maintain acceptable productivity and turnaround times for all assignments Maintain high work accuracy and quality scores Support team with versatile assignments related to department needs
Desired Minimum Qualifications
Proficiency in Microsoft product suite (i.e. Microsoft Office, Word, Excel, etc.) Strong analytical, problem solving and negotiating skills Ability to adapt quickly in fast paced environment Detail oriented with exceptional organizational and communication skills Complete Fluency in English, Spanish (Portuguese a plus) Proven ability to work independently and meet determined deadlines Ability to navigate and enter data utilizing multiple systems and screens
Education And Experience
Associates Degree or commensurate work experience Billing/Coding Certification preferred Minimum of 3 years experience in Health Insurance Industry Seniority level
Seniority level Mid-Senior level Employment type
Employment type Other Job function
Job function Finance and Sales Industries Insurance Referrals increase your chances of interviewing at Best Doctors Insurance by 2x Sign in to set job alerts for “Claims Adjuster” roles.
Claims Rep - Auto (REMOTE- Exp required w/State License)
Commercial Casualty Adjuster - Represented
MULTI-LINE ADJUSTER - FLORIDA MIAMI AREA
Independent Insurance Claims Adjuster in Dania, Florida
Independent Insurance Claims Adjuster in Hollywood, Florida
Independent Insurance Claims Adjuster in Miami, Florida
Independent Insurance Claims Adjuster in Fort Lauderdale, Florida
Independent Insurance Claims Adjuster in Miami Beach, Florida
Independent Insurance Claims Adjuster in North Miami Beach, Florida
Personal Injury Protection Claims Adjuster I, II or Sr - National General
Miami-Fort Lauderdale Area $60,000.00-$99,000.00 1 day ago Independent Insurance Claims Adjuster in Hallandale, Florida
Personal Injury Protection Claims Adjuster I, II or Sr - National General
Miami-Fort Lauderdale Area $60,000.00-$99,000.00 1 day ago Independent Insurance Claims Adjuster in Hialeah, Florida
Independent Insurance Claims Adjuster in Opa Locka, Florida
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr