Medical Claims Officer 21N25

The role of a Medical Claims Officer is pivotal in the healthcare and insurance industries, ensuring that patient claims are processed efficiently and accurately. The main responsibility of a Medical Claims Officer is to manage, evaluate, and process health insurance claims in accordance with company policies and industry regulations. This role requires a keen eye for detail, strong organizational skills, and the ability to work under tight deadlines. The officer will interact regularly with healthcare providers, policyholders, and colleagues to ensure that correct information is gathered and verified, claim payments are expedited, and any discrepancies are resolved. Join our team and help facilitate the seamless approval and reimbursement processes for healthcare claims, contributing to the financial well-being of our clients.

Responsibilities

• Review and process medical insurance claims in a timely and accurate manner.
• Ensure compliance with industry regulations and company policies during claims assessment.
• Communicate with healthcare providers to obtain additional information as needed.
• Verify the accuracy of information on insurance claim forms and correct any errors.
• Maintain and update claims records and related documentation effectively.
• Manage denied claims appeals by reviewing, editing, and resubmitting them.
• Identify patterns of claims fraud and report them to the appropriate departments.
• Prepare and present detailed claims reports for management review and decision-making.
• Liaise with policyholders to clarify issues related to claims and coverage.
• Utilize computerized systems to track, organize, and oversee claim cases.
• Assist in training new team members on standard claims processing procedures.
• Continuously update knowledge on insurance laws, coding, and billing procedures.

Requirements

• Bachelor's degree in business administration, healthcare management, or related field.
• Previous experience in medical claims processing or insurance industry required.
• Strong analytical skills with the ability to interpret complex information.
• Excellent organizational and multitasking abilities to manage high workloads.
• Good communication skills to interact effectively with different stakeholders.
• Proficient in using claims processing software and Microsoft Office Suite.
• Knowledge of medical terminology, coding, and billing processes is essential.