Medical Claims Officer (225-1011)

We are seeking a highly detailed-oriented and dedicated Medical Claims Officer to join our dynamic team. The successful candidate will be responsible for managing and processing medical claims to ensure efficient, accurate, and timely handling and resolution. You will serve as a critical link between healthcare providers, insurance companies, and patients, ensuring that all parties receive and understand the necessary information for processing claims. This role is essential in ensuring that our customers and clients receive prompt service, as well as assisting in the minimization of fraud and unnecessary costs. As a Medical Claims Officer, you will work within a team environment but also need to demonstrate a high degree of autonomy as you manage your workload efficiently, interpret medical data, and ensure compliance with relevant policies and regulations.

Responsibilities

• Receive and review medical claims from healthcare providers for accuracy and completeness.
• Verify patient insurance coverage and eligibility for medical claims processing.
• Investigate discrepancies in claims and liaise with healthcare providers to resolve issues.
• Process medical claims in accordance with policy and procedure guidelines.
• Communicate with insurance companies to expedite claim settlements effectively.
• Compile data and prepare detailed reports for management review and analysis.
• Maintain accurate and up-to-date claim files and records in the system.
• Ensure compliance with federal and state regulations and company policies.
• Assist with training new team members and provide ongoing support as required.
• Develop and maintain strong professional relationships with clients and third-party payers.
• Handle and resolve patient or provider inquiries and complaints promptly and courteously.
• Identify trends in claims processing to recommend improvements and efficiencies.

Requirements

• Bachelor’s degree in healthcare management, finance, or a related field preferred.
• Minimum of 2 years of experience in medical claims processing or related roles.
• Strong understanding of medical insurance terminology and billing codes.
• Excellent attention to detail and ability to spot errors in documentation.
• Proficient in using relevant software for claims processing and data entry.
• Excellent communication and customer service skills for dealing with inquiries.
• Strong problem-solving skills to resolve discrepancies in claims effectively.