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Form of workJob Description
We are looking for an experienced, detail-oriented, and highly analytical Senior Medical Claims Processor to join our dynamic team. The Senior Medical Claims Processor will be responsible for reviewing Medical Claims to determine the medical insurance company's liability. The ideal candidate will have a strong knowledge of medical terminology, coding, and insurance policies, with a keen eye for identifying discrepancies or fraud.
Responsibilities:
1. Assess and settle insurance claims in accordance with company policies and procedures. 2. Examine claims submitted by policyholders, medical facilities, or physicians to decide whether the claims should be paid or denied. 3. Coordinate with healthcare providers and medical professionals to gather all information necessary to process claims. 4. Review medical reports, physicians' notes, and other relevant documents for completeness and accuracy. 5. Identify and investigate any suspicious or fraudulent claims. 6. Maintain records of claims processed and prepare reports for management. 7. Recommend litigation by the legal department in case of dubious and non-meritorious claims. 8. Keep up-to-date with changes in legislation, industry practices, and medical coding updates.Qualifications: A minimum of 1-3 years of experience as a Medical Claims Examiner or a similar role in the health insurance industry. Strong knowledge of healthcare insurance policies, medical terminology, and coding (ICD and CPT). Excellent analytical skills with the ability to pay meticulous attention to detail. Computer literacy and proficiency in common office software, especially Microsoft Office, and industry-specific technology.
Responsibilities:
1. Assess and settle insurance claims in accordance with company policies and procedures. 2. Examine claims submitted by policyholders, medical facilities, or physicians to decide whether the claims should be paid or denied. 3. Coordinate with healthcare providers and medical professionals to gather all information necessary to process claims. 4. Review medical reports, physicians' notes, and other relevant documents for completeness and accuracy. 5. Identify and investigate any suspicious or fraudulent claims. 6. Maintain records of claims processed and prepare reports for management. 7. Recommend litigation by the legal department in case of dubious and non-meritorious claims. 8. Keep up-to-date with changes in legislation, industry practices, and medical coding updates.Qualifications: A minimum of 1-3 years of experience as a Medical Claims Examiner or a similar role in the health insurance industry. Strong knowledge of healthcare insurance policies, medical terminology, and coding (ICD and CPT). Excellent analytical skills with the ability to pay meticulous attention to detail. Computer literacy and proficiency in common office software, especially Microsoft Office, and industry-specific technology.
