Medical Claims Officer (225-929)

A Medical Claims Officer plays a vital role in the healthcare system by managing and processing insurance claims related to medical services provided to patients. Their key responsibility is to review and assess medical insurance claims, ensuring that the claims are processed accurately and promptly. This position requires a strong understanding of medical billing, coding, insurance policies, and healthcare regulations. The Medical Claims Officer acts as a liaison between insurance companies, healthcare providers, and patients, ensuring that all parties involved understand the claims process and any decisions made regarding claims. They must be detail-oriented and analytical, with excellent communication skills to negotiate and resolve discrepancies in claims. The role is crucial to maintaining the financial integrity of healthcare providers while also ensuring that patients receive the coverage to which they are entitled.

Responsibilities

• Review medical claims for accuracy and completeness before processing.
• Analyze and resolve discrepancies in claims by coordinating with involved parties.
• Ensure compliance with medical insurance billing regulations and guidelines.
• Prepare detailed reports on claims processed and their outcomes.
• Communicate effectively with patients and providers regarding claim status and issues.
• Verify the legitimacy of claims through extensive research and review of policy terms.
• Coordinate with healthcare providers to obtain necessary documentation for claims.
• Assist in the resolution of outstanding claims issues and conflicts.
• Advise healthcare providers and policyholders on best practices in claims submission.
• Keep detailed records of all interactions and transactions related to claims.
• Conduct audits on processed claims to maintain accuracy and compliance.
• Stay updated with changes in insurance policies and healthcare regulations.

Requirements

• Bachelor's degree in Healthcare Management, Business, or a related field preferred.
• Minimum of two years experience in medical claims processing or related field.
• Strong knowledge of medical billing and coding systems and regulations.
• Excellent analytical skills with high attention to detail and accuracy.
• Outstanding communication skills, both written and verbal, for varied interactions.
• Ability to handle sensitive information with the highest degree of integrity and confidentiality.
• Proficiency in using medical claims software and standard office applications.