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Title
Text copied to clipboard!Medical Insurance Claims Adjuster
Description
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We are looking for a detail-oriented and analytical Medical Insurance Claims Adjuster to join our team. In this role, you will be responsible for reviewing, investigating, and processing medical insurance claims to determine the extent of the insurance company's liability. You will work closely with healthcare providers, policyholders, and other insurance professionals to ensure claims are handled accurately and efficiently.
As a Medical Insurance Claims Adjuster, you will analyze medical records, billing codes, and policy documents to assess the validity of claims. You will also communicate with claimants and medical professionals to gather additional information when necessary. Your ability to interpret complex medical and insurance terminology will be essential in making informed decisions.
This position requires a strong understanding of healthcare procedures, insurance policies, and regulatory compliance. You must be able to work independently, manage multiple claims simultaneously, and meet strict deadlines. Attention to detail, critical thinking, and excellent communication skills are key to success in this role.
We offer a supportive work environment, opportunities for professional development, and a comprehensive benefits package. If you are passionate about helping people navigate the insurance process and have a background in medical claims or healthcare administration, we encourage you to apply.
Responsibilities
Text copied to clipboard!- Review and evaluate medical insurance claims for accuracy and completeness
- Investigate claims by gathering relevant medical records and documentation
- Determine coverage and liability based on policy terms and conditions
- Communicate with healthcare providers and policyholders to obtain additional information
- Ensure compliance with federal and state insurance regulations
- Calculate claim payments and issue approvals or denials
- Document claim decisions and maintain accurate records
- Collaborate with other departments such as underwriting and legal
- Identify potential fraud and escalate suspicious claims
- Provide excellent customer service to claimants and providers
Requirements
Text copied to clipboard!- Bachelor’s degree in healthcare administration, insurance, or related field
- 2+ years of experience in medical claims adjusting or healthcare billing
- Strong knowledge of medical terminology and coding (ICD-10, CPT)
- Familiarity with insurance policies and regulatory guidelines
- Excellent analytical and problem-solving skills
- Strong written and verbal communication abilities
- Proficiency in claims management software and Microsoft Office
- Ability to handle confidential information with discretion
- Detail-oriented with strong organizational skills
- Ability to work independently and manage multiple tasks
Potential interview questions
Text copied to clipboard!- Do you have experience processing medical insurance claims?
- Are you familiar with ICD-10 and CPT coding systems?
- How do you ensure accuracy when reviewing complex medical records?
- Can you describe a time you identified a fraudulent claim?
- What claims management software have you used?
- How do you stay updated on changes in insurance regulations?
- Describe your approach to handling a denied claim appeal.
- How do you prioritize multiple claims with tight deadlines?
- What steps do you take to maintain confidentiality?
- Have you worked with both providers and policyholders before?
