Claims Examiner jobs in Miami, FL

About Us

Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.

Position Summary

The claim examiner is responsible for timely and accurate data entry and adjudication of medical and hospital claims.

Essential Functions

• Examine, data enter, calculate and adjudicate insurance claims complying with federal, state and county laws, plan policy and company procedures
• Enter codes and verify data for computer processing
• Maintain individual production count
• Update and maintain policy manual timely
• Assist in provider services call center as needed.

Complete miscellaneous assignments upon request

Education and Experience

• High School Diploma/GED required; college course work preferred. 
• Experience processing UB04 and CMS 1500 claims
• Self-starter, conscientious, independent worker.
• Strong knowledge of Customer Service skills and techniques required.
• Excellent written, verbal and grammatical communication skills required.
• Ability to read, interpret, analyze technical / business procedures and / or governmental regulations required.
• Ability to write reports, business correspondence and procedural manuals required.
• Knowledge of automated systems (technical adeptness) required.
• Demonstrated proficiency in Microsoft programs (ie, Excel, Word, PowerPoint) required; knowledge of Microsoft Access preferred.

EEO Statement

In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company’s equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace.

Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.