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Title
Text copied to clipboard!Health Claims Analyst
Description
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We are looking for a dedicated Health Claims Analyst to support our healthcare services team. In this role, you will be responsible for analyzing, evaluating, and processing health insurance claims. You will work closely with medical professionals, insurance companies, and internal departments to ensure that all claims are handled accurately, efficiently, and in compliance with applicable regulations.
Your main tasks will include reviewing submitted medical documents, assessing claim eligibility, and identifying potential irregularities or fraud. You will use modern software tools for data analysis and documentation and actively contribute to the optimization of internal processes. A deep understanding of medical terminology, billing codes, and legal regulations is essential for this position.
Additionally, you will serve as a point of contact for inquiries from insured individuals and medical service providers, assisting in the resolution of complex issues. Your analytical skills, attention to detail, and strong communication abilities make you a valuable member of our team.
We offer a dynamic work environment, continuous training opportunities, and the chance to make a meaningful contribution to quality and fairness in healthcare. If you have a passion for data analysis and healthcare management, we look forward to your application.
Responsibilities
Text copied to clipboard!- Analyze and process health insurance claims
- Review medical documents and billing statements
- Assess claim eligibility according to guidelines
- Detect and report irregularities or fraud attempts
- Communicate with insured individuals and medical providers
- Collaborate with internal departments and external partners
- Use software tools for data analysis and documentation
- Optimize claims management processes
- Ensure compliance with legal and internal policies
- Prepare reports and analyses for management
Requirements
Text copied to clipboard!- Degree in healthcare management, business administration, or related field
- Experience in health insurance or healthcare sector
- Knowledge of medical terminology and billing systems (e.g., ICD, DRG)
- Analytical thinking and high attention to detail
- Proficiency in MS Office and data analysis tools
- Strong verbal and written communication skills
- Team player with ability to work independently
- Familiarity with data protection and compliance regulations
- Resilience and organizational skills
- Willingness to engage in continuous learning
Potential interview questions
Text copied to clipboard!- What experience do you have with processing health claims?
- How do you handle complex medical documentation?
- Which data analysis tools have you used before?
- How do you ensure compliance with legal requirements?
- How do you detect potential fraud in insurance claims?
- How do you manage conflicts between insured individuals and providers?
- What role does teamwork play in this position for you?
- How do you stay informed about changes in healthcare law?
- How do you prioritize your tasks during the workday?
- What motivates you to work with health data?
