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Title

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Health Insurance Claims Analyst

Description

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We are looking for a detail-oriented and experienced Health Insurance Claims Analyst to join our team. The successful candidate will be responsible for reviewing, analyzing, and processing health insurance claims. They will also be responsible for identifying trends, determining the validity of a claim, and liaising with healthcare providers and policyholders to gather more information. The ideal candidate will have a strong understanding of medical terminology, coding, and billing procedures. They will also have excellent analytical skills, with the ability to interpret complex data and make accurate decisions. This role requires a high level of accuracy and attention to detail, as well as excellent communication skills to effectively interact with various stakeholders.

Responsibilities

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  • Reviewing and analyzing health insurance claims
  • Determining the validity of a claim
  • Liaising with healthcare providers and policyholders to gather more information
  • Identifying trends in claims
  • Interpreting complex data
  • Making accurate decisions based on data analysis
  • Understanding and applying medical terminology, coding, and billing procedures
  • Maintaining accurate records of all claims
  • Communicating effectively with various stakeholders
  • Ensuring compliance with all relevant regulations and guidelines

Requirements

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  • Bachelor's degree in a related field
  • Previous experience in a similar role
  • Strong understanding of medical terminology, coding, and billing procedures
  • Excellent analytical skills
  • Ability to interpret complex data
  • High level of accuracy and attention to detail
  • Excellent communication skills
  • Strong decision-making skills
  • Ability to work under pressure and meet deadlines
  • Knowledge of relevant regulations and guidelines

Potential interview questions

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  • Can you describe your experience with health insurance claims?
  • How do you ensure accuracy when analyzing complex data?
  • Can you explain how you would determine the validity of a claim?
  • How do you handle pressure and tight deadlines?
  • Can you describe a time when you had to make a difficult decision based on your data analysis?