Claims and Data Specialist
4 days ago
We are seeking a detail-oriented professional to join our insurance team as a claims processor. This role involves preparing claim forms, verifying information, and corresponding with agents and beneficiaries.
The successful candidate will be responsible for handling client inquiries, reviewing policies, determining coverage, calculating claim amounts, and processing payments.
Main Responsibilities:
- A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company.
- Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information.
- In addition, a processor must keep meticulous records of claims and follow up on lapsed cases.
- Medical claims processors are expected to have an extensive knowledge of medical terminology, as well as experience using a computer.
- Recording and maintaining insurance policy and claims information in a database system.
- Determining policy coverage and calculating claim amounts.
- Processing claims payments.
- Answering queries related to policy coverage criteria and guidelines.
- Complying with federal, state, and company regulations and policies.
- Since medical claims processors must approve or deny payment to doctors, it is vital that they know how to correctly read and assess medical documents.
- Good communication skills are necessary to converse with doctors' offices or insurance companies if there is a problem with the claim.
- Performing other clerical tasks, as required.
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