Medical Claims Officer 05D25

A Medical Claims Officer is a vital part of the healthcare industry, responsible for processing insurance claims related to medical services. They play a crucial role in ensuring that healthcare providers receive accurate and timely payments from insurance companies. This role requires a thorough understanding of medical terminology, insurance policies, and billing procedures. The Medical Claims Officer acts as a liaison between healthcare providers and insurance companies, facilitating communication and resolving any discrepancies or issues that may arise. Attention to detail, strong analytical skills, and the ability to work under pressure are essential attributes for this position. A successful Medical Claims Officer will ensure both compliance with regulations and high levels of customer satisfaction.

Responsibilities

• Review and process medical insurance claims with accuracy and efficiency.
• Ensure submitted claims comply with insurance policy guidelines and regulations.
• Maintain and update accurate records of claims in the system database.
• Collaborate with healthcare providers to resolve discrepancies in claim details.
• Communicate effectively with insurance companies to verify policy holder information.
• Prepare and submit detailed claims reports for management review and analysis.
• Provide excellent customer service to clients and resolve claim-related inquiries.
• Identify and report any suspicious or fraudulent claims to supervisors immediately.
• Assist in training new staff members on claims processing procedures and software.
• Stay updated with changes in medical billing codes and regulatory policies.
• Analyze claims data to identify trends and areas for process improvement.
• Coordinate with other departments to streamline claims processing operations.

Requirements

• Bachelor’s degree in healthcare administration, finance, or related field preferred.
• Minimum of two years’ experience in medical claims processing or similar role.
• Strong understanding of medical terminology and insurance billing codes.
• Proficient in using claims processing software and office productivity tools.
• Excellent communication skills, both written and verbal, are essential.
• Strong analytical skills and attention to detail in reviewing claims documents.
• Ability to work independently and manage multiple tasks under tight deadlines.