Cart $0.00
Recruiting and Hiring Advice
 

Job Descriptions

This medical claims specialist/examiner sample job description can assist in your creating a job application that will attract job candidates who are qualified for the job. Feel free to revise this job description to meet your specific job duties and job requirements.

Description: Medical Claims Specialist/Examiner

Medical Claims Specialist/Examiner Job Purpose:
Serves medical insurance customers by determining insurance coverage; examining and resolving medical claims; documenting actions; maintaining quality customer services; ensuring legal compliance.

Medical Claims Specialist/Examiner Job Duties:

  • Determines covered medical insurance losses by studying provisions of policy or certificate.
  • Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims.
  • Documents medical claims actions by completing forms, reports, logs, and records.
  • Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter.
  • Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.
  • Maintains quality customer services by following customer service practices; responding to customer inquiries.
  • Provides legal support by assembling documentation for settlement action.
  • Protects operations by keeping claims information confidential.
  • Prepares reports by collecting, analyzing, and summarizing information.
  • Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
  • Accomplishes organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.

Skills/Qualifications: Claims Adjustment, Financial Software, Documentation Skills, Data Entry Skills, Analyzing Information , Problem Solving, Verbal Communication, Customer Focus, FDA Health Regulations, General Math Skills, Statistical Analysis

Find out more about how to hire:

 

 
 

*=Required
(email address)
(email address)

Your email has been sent. Thank you.
Print this page