Medical Claims Officer 05N25

As a Medical Claims Officer, you will play a critical role in the healthcare insurance industry by ensuring that medical claims are processed accurately and efficiently. You will be responsible for reviewing and processing medical claims submitted by healthcare providers, ensuring compliance with health insurance policies, and verifying the accuracy of the information provided. Working closely with other departments, you will address any discrepancies, provide feedback to healthcare providers, and communicate claim adjudications. You will also be tasked with maintaining accurate records and generating reports for internal assessment. This position requires a high level of attention to detail, strong communication skills, and a good understanding of medical terminology and insurance processes.

Responsibilities

• Review and process medical claims in accordance with company policies and procedures.
• Ensure compliance with health insurance policies and regulatory requirements.
• Verify the accuracy and completeness of information provided in medical claims.
• Communicate effectively with healthcare providers regarding claim discrepancies and resolutions.
• Collaborate with internal teams to resolve claim issues and improve processing efficiency.
• Maintain accurate and organized records of all claims processed and adjudicated.
• Provide clear and timely feedback to healthcare providers on claim submissions.
• Identify trends in claim submissions and suggest improvements to the claims process.
• Prepare detailed reports for management on claim processing activities and outcomes.
• Assist in training new staff members in claims processing and policy compliances.
• Participate in quality assurance audits to ensure claims are processed accurately.
• Stay up to date with changes in medical billing codes and insurance regulations.

Requirements

• Bachelor’s degree in healthcare administration, business, or related field preferred.
• Minimum of two years of experience in medical claims processing or related field.
• Excellent knowledge of healthcare insurance policies and medical billing codes.
• Strong analytical skills and attention to detail in reviewing claims information.
• Proficient in using claims processing software and other relevant computer applications.
• Effective communication skills to interact with healthcare providers and internal teams.
• Able to work independently and manage multiple tasks in a fast-paced environment.