Insurance Phone Interviewer/Underwriter
PrideStaff, Clearwater, FL, United States
Our client, a leading insurance administrative services provider, is seeking a detail-oriented professional with a strong background in clinical terminology, prescription drugs, and medical coding. This is a specialized, public-facing role where you will serve as a primary decision-maker for Medicare Supplement policy underwriting.
Unlike standard data entry positions, this role empowers you to use your clinical expertise to investigate claims, interpret insurance contracts, and make final eligibility determinations. This position is ideal for a Pharmacy Technician, Medical Coder, or Claims Adjuster looking to transition into a high-level corporate decision-making environment.
Primary Duties and Responsibilities
Analyze and adjudicate medical and prescription drug claims based on specific policy contracts.
Conduct clinical investigations to determine insurance carrier liability and coverage extent.
Serve as a subject matter expert in a professional call-center environment to explain underwriting determinations to policyholders.
Research complex medical histories and drug indications to identify underlying health conditions.
Ensure all processed claims meet strict regulatory standards and internal accuracy requirements.
Identify discrepancies in billing forms (HCFA-1500 and UB-04) to prevent payment errors and ensure quality control.
Experience and Qualifications
At least 1 year of experience in medical insurance, pharmacy, or clinical coding is required.
Strong familiarity with medical terminology and the ability to map medications to their corresponding medical conditions (ICD-10).
Direct experience with Medicare claims, specifically Medicare Supplement or Medicare Advantage, is highly preferred.
Proven ability to accurately interpret Explanations of Benefits (EOBs) and institutional billing forms.
Excellent verbal and written communication skills for articulating complex decisions to the public.
A decisive mindset with a track record of making critical, high-stakes determinations in a professional setting.
Proficiency in Microsoft Office and general computer navigation.
Compensation / Pay Rate (Up to): $24.50
Unlike standard data entry positions, this role empowers you to use your clinical expertise to investigate claims, interpret insurance contracts, and make final eligibility determinations. This position is ideal for a Pharmacy Technician, Medical Coder, or Claims Adjuster looking to transition into a high-level corporate decision-making environment.
Primary Duties and Responsibilities
Analyze and adjudicate medical and prescription drug claims based on specific policy contracts.
Conduct clinical investigations to determine insurance carrier liability and coverage extent.
Serve as a subject matter expert in a professional call-center environment to explain underwriting determinations to policyholders.
Research complex medical histories and drug indications to identify underlying health conditions.
Ensure all processed claims meet strict regulatory standards and internal accuracy requirements.
Identify discrepancies in billing forms (HCFA-1500 and UB-04) to prevent payment errors and ensure quality control.
Experience and Qualifications
At least 1 year of experience in medical insurance, pharmacy, or clinical coding is required.
Strong familiarity with medical terminology and the ability to map medications to their corresponding medical conditions (ICD-10).
Direct experience with Medicare claims, specifically Medicare Supplement or Medicare Advantage, is highly preferred.
Proven ability to accurately interpret Explanations of Benefits (EOBs) and institutional billing forms.
Excellent verbal and written communication skills for articulating complex decisions to the public.
A decisive mindset with a track record of making critical, high-stakes determinations in a professional setting.
Proficiency in Microsoft Office and general computer navigation.
Compensation / Pay Rate (Up to): $24.50