ABOUT INSURANCE ADMINISTRATIVE SOLUTIONSInsurance Administrative Solutions (IAS) is a third-party provider of comprehensive administrative solutions for our clients in the insurance industry. We offer a business process outsourcing solution that helps insurers optimize administrative workload, bolster their industry expertise, leverage emerging technologies, and streamline operations. With strong industry knowledge, we deliver value to our customers by providing compassionate customer service, efficient processing, and quality results. Here at IAS, we embrace the fact that great things are only accomplished by working as a team. We believe that all of our employees have valuable input no matter the level. Our highly collaborative team environment offers each of our employees a place where they can excel.

Location: Rome, GA

JOB SUMMARY: This position is responsible for analyzing and researching medical claims by reviewing medical records and billing documentation. This position involves extensive research, written and telephonic correspondence and review of medical records and other documents for eligibility determination.

Candidate must be local. This is not a remote position, at this time.

ESSENTIAL DUTIES & RESPONSIBILITIES (other duties may be assigned as necessary):

• Conducting investigations into claimant health history through review of medical records and billing documentation
• Interpreting insurance contract benefits and definitions
• Making decisions about claim payments and claimant eligibility

EDUCATION and/or EXPERIENCE REQUIRED:

• 3-5 years RN hospital nursing experience or other equivalent hands-on medical industry experience
• Oncology, cardiology, or surgery preferred
• Previous experience with chart review
• Knowledge of medical terminology and conditions
• Knowledge of medical prognoses and treatment
• Excellent oral and written communication skills
• Intermediate experience with Microsoft Word and Excel
• Highest standards of accuracy and attention to detail

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Medical terminology is needed. Previous Cancer, Health, Medicare, Rx claims adjudication preferred. Must have organizational and decision making skills. Ability to work independently and exhibit flexibility in performing multiple functions. Team centered with excellent work ethic and reliability. Good PC application skills a plus. Ability to read and interpret EOB's. Clear understanding of the policy benefits and procedures within the Claims department. Honesty, as well as respect, for the company and its policies & procedures is crucial.

SCHEDULE:

• Monday to Friday
• 20 - 24 hour work week

IAS is an equal opportunity employer.