Medical Claims Officer (225-816)

As a Medical Claims Officer, you will play a critical role in the healthcare industry, managing and processing insurance claims related to medical procedures and treatments. You will be responsible for ensuring claims are processed accurately and in a timely manner, maintaining compliance with all relevant policies and legal requirements. This position requires a keen eye for detail, excellent organizational skills, and a thorough understanding of healthcare billing and coding systems. You will communicate with healthcare providers, insurance companies, and patients to resolve discrepancies and ensure that reimbursement processes run smoothly. Your contributions will directly impact the financial operations of healthcare services and the satisfaction of insurance policyholders.

Responsibilities

• Review insurance claims for completeness and compliance with policy coverage.
• Process medical claims accurately while following established procedures and protocols.
• Communicate with healthcare providers to gather necessary documentation for claims.
• Analyze insurance policies to determine coverage eligibility for medical procedures.
• Coordinate with insurance companies to resolve issues and facilitate claim approvals.
• Investigate discrepancies or delays in claim processing to ensure timely payments.
• Maintain detailed records of claims processed and update patient accounts accordingly.
• Ensure compliance with industry regulations and company internal policies for claim handling.
• Provide exceptional customer service by answering inquiries and addressing policyholder concerns.
• Assist in identifying areas for process improvement to enhance claim department efficiency.
• Generate regular reports on claims status, approvals, denials, and payment timelines.
• Collaborate with team members to achieve departmental goals and objectives continuously.

Requirements

• Bachelor’s degree in healthcare administration, business, or related field preferred.
• Minimum of 2 years experience in medical claims processing or related area required.
• Thorough understanding of healthcare billing, coding systems, and insurance procedures.
• Strong analytical skills with the ability to interpret medical and billing reports.
• Excellent communication skills to interact effectively with policyholders and providers.
• Proficiency in using claims management software and office productivity tools.
• Attention to detail and the ability to handle confidential information appropriately.