Medical Claims Call Center Representative

Medical Claims Call Center Representative

Insurance Administrative Solutions, L.L.C. ("IAS"), an Integrity company headquartered in Clearwater, Florida, is a third-party administrator providing business process outsourcing for insurance carriers. Formed in 2002, IAS administers policies for insureds residing all across the United States.

Job Summary:

Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions to provide prompt, courteous customer service, which meets or exceeds service standards. Interpret contract benefits in accordance with specific claims processing guidelines.

Primary Responsibilities:

• Interpret contract benefits accurately to policyholder, agents, and providers.
• Provide claim status to policyholders or providers.
• Send out refund request letters and follow-up as necessary.
• Produce correspondence to customers.
• Answer calls as required by company policy in a helpful, professional, timely manner.
• Place outgoing calls as needed to provide or obtain information.
• Document (written/on-line) all calls while in progress.
• Transfer calls to employees in other departments as required to meet customer needs.
• Fully document policy file or imaging system with all related material so as to leave a clear and concise audit trail.
• Actively participate in cross training and group training sessions to maximize team efficiency and maintain or exceed service standards.
• Communicate problems identified relevant to the claims processing system to the appropriate people.
• Maintain external contacts with policyholders, providers of service, agents, attorneys and other carriers as well as internal contacts with peers, management, and other support areas with a positive and professional approach.
• Communicate openly with Supervisor, Team Lead and other team members to ensure accurate responses and avoid duplication of efforts.

Primary Skills & Requirements:

• A high school diploma or GED equivalent.
• Insurance background preferred
• 0-2 years of proven customer support experience; prior call center experience preferred
• Strong phone contact handling skills and active listening
• Familiarity with Microsoft Office products
• Ability to adapt and respond to different types of people and tasks
• Excellent communication and documentation skills
• Ability to multi-task, prioritize, and manage time effectively and efficiently
• Reliable transportation and the ability to be punctual and dependable
• May have agent license but no active appointments

Benefits Available

• We value flexibility and recognize the importance of work‑life balance. This role will begin as fully onsite to support learning and team integration. As proficiency is demonstrated, hybrid work opportunities may be introduced, dependent on business needs and department practices.
• Medical/Dental/Vision Insurance
• 401(k) Retirement Plan
• Paid Holidays
• PTO
• Community Service PTO
• FSA/HSA
• Life Insurance
• Short-Term and Long-Term Disability

About Integrity

Integrity is one of the nation's leading independent distributors of life, health and wealth insurance products. With a strong insurtech focus, we embrace a broad and innovative approach to serving agents and clients alike. Integrity is driven by a singular purpose: to help people protect their life, health and wealth so they can prepare for the good days ahead.

Integrity offers you the opportunity to start a career in a family-like environment that is rewarding and cutting edge. Why? Because we put our people first! At Integrity, you can start a new career path at company you'll love, and we'll love you back. We're proud of the work we do and the culture we've built, where we celebrate your hard work and support you daily. Joining us means being part of a hyper-growth company with tons of professional opportunities for you to accelerate your career. Integrity offers our people a competitive compensation package, including benefits that make work more fun and give you and your family peace of mind.

Headquartered in Dallas, Texas, Integrity is committed to meeting Americans wherever they are — in person, over the phone or online. Integrity's employees support hundreds of thousands of independent agents who serve the needs of millions of clients nationwide. For more information, visit Integrity.com.

Integrity, LLC is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability, veteran status, or any other characteristic protected by federal, state, or local law. In addition, Integrity, LLC will provide reasonable accommodations for qualified individuals with disabilities.