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Title
Text copied to clipboard!Health Insurance Claims Specialist
Description
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We are looking for a Health Insurance Claims Specialist. This position is responsible for reviewing, evaluating, and processing claims submitted under health insurance policies. The ideal candidate should be well-versed in insurance regulations, detail-oriented, and possess a customer-focused approach. The claims specialist plays a key role in ensuring fair and timely claim assessments, contributing to both customer satisfaction and regulatory compliance.
In this role, the specialist will analyze health insurance claims, collect necessary documentation, review medical reports, and make decisions based on policy coverage. The role also involves communicating with doctors, hospitals, and other healthcare providers to gather information and, when necessary, speaking directly with policyholders. The claims specialist must also be vigilant in identifying and preventing potential fraud.
The ideal candidate will have experience in the insurance industry, knowledge of healthcare systems, and strong communication skills. Proficiency in computer systems and reporting is also essential. This position requires the ability to work both independently and collaboratively within a team.
Our company offers continuous development opportunities and values ethical standards. As a Health Insurance Claims Specialist, you will be expected to protect the interests of both the company and the insured, ensuring a fair and transparent claims evaluation process.
Responsibilities
Text copied to clipboard!- Review and evaluate health insurance claims
- Collect and verify required documentation
- Analyze medical reports for policy compliance
- Communicate with policyholders, healthcare providers, and physicians
- Identify and prevent potential fraud
- Document and report claim decisions in systems
- Ensure customer satisfaction through effective communication
- Comply with legal regulations and company policies
- Coordinate with relevant departments
- Stay updated on insurance legislation
Requirements
Text copied to clipboard!- Bachelor’s degree in relevant fields (preferably insurance, healthcare management)
- Minimum 2 years of experience in health insurance claims management
- Knowledge of insurance regulations
- Familiarity with medical terminology and healthcare systems
- Proficiency in MS Office and claims management systems
- Analytical thinking and problem-solving skills
- Strong communication and negotiation skills
- Detail-oriented and result-driven
- Team player
- Commitment to ethics and confidentiality
Potential interview questions
Text copied to clipboard!- How much experience do you have in health insurance claims processes?
- How proficient are you in evaluating medical documents?
- What is your approach to detecting fraud?
- How do you handle difficult customers?
- Which claims management systems have you used?
- How do you stay updated on insurance regulations?
- How do you contribute to team collaboration?
- How do you stay organized under high workload?
- What do you do to improve customer satisfaction?
- How do you handle ethical dilemmas?
