Medical Claims Officer 27J25

The Medical Claims Officer is a crucial member of the healthcare administration team, responsible for processing and evaluating insurance claims related to medical services. This role involves assessing claims, verifying the accuracy of the information, and ensuring that the claims comply with the applicable policies and procedures of the insurance provider. The Medical Claims Officer serves as a liaison between the insurance company, healthcare providers, and patients to facilitate the claims process smoothly and efficiently. It is essential for the officer to have strong attention to detail, excellent communication skills, and the ability to solve complex issues. The position demands a thorough understanding of medical terminology, claims processing software, and insurance guidelines to process and adjudicate claims correctly. Successful candidates should thrive in a fast-paced environment and be committed to providing high-quality service while meeting deadlines and maintaining confidentiality.

Responsibilities

• Review and assess medical insurance claims in accordance with company policies.
• Verify the accuracy of medical information and documentation submitted with claims.
• Engage with healthcare providers to clarify documentation discrepancies and requirements.
• Communicate effectively with insured individuals regarding the status of their claims.
• Ensure compliance with all regulatory requirements and internal procedures.
• Accurately input data into the claims processing system and update records accordingly.
• Identify potential fraudulent claims and escalate them for further investigation.
• Coordinate with various departments to facilitate the resolution of claims disputes.
• Assist in the analysis of claims data to improve processing efficiency and accuracy.
• Provide training and support to new team members on claims processing policies.
• Generate detailed reports on claims processing activities and outcomes for management review.
• Maintain knowledge of changes in insurance laws and medical billing practices.

Requirements

• Associate’s degree or equivalent experience in healthcare administration or related field.
• At least two years of experience in medical claims processing or a related role.
• Familiarity with medical billing codes and terminology for effective claim assessments.
• Proficiency in using claims processing software and Microsoft Office applications.
• Strong analytical skills and attention to detail to ensure claim accuracy.
• Excellent communication skills, both written and verbal, for interacting with stakeholders.
• Demonstrated ability to handle sensitive information with confidentiality and professionalism.