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Title
Text copied to clipboard!Medical Insurance Claims Assessor
Description
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We are looking for a detail-oriented and analytical Medical Insurance Claims Assessor to join our team. In this role, you will be responsible for reviewing, evaluating, and processing medical insurance claims to ensure compliance with policy terms and regulatory requirements. You will work closely with healthcare providers, policyholders, and internal departments to verify the accuracy of submitted claims and determine appropriate coverage and reimbursement levels.
The ideal candidate will have a strong understanding of medical terminology, insurance policies, and claims processing procedures. You should be comfortable working with large volumes of data, possess excellent decision-making skills, and be able to communicate effectively with various stakeholders. Experience with claims management software and knowledge of healthcare regulations such as HIPAA is highly desirable.
As a Medical Insurance Claims Assessor, your primary goal will be to ensure that claims are processed accurately, fairly, and in a timely manner. You will play a critical role in maintaining the integrity of the claims process and supporting the financial health of both the insurance provider and the insured individuals.
This position offers an opportunity to work in a dynamic and fast-paced environment where attention to detail and a commitment to quality are essential. If you are passionate about healthcare and insurance and enjoy problem-solving, this could be the perfect role for you.
Responsibilities
Text copied to clipboard!- Review and assess medical insurance claims for accuracy and completeness
- Verify patient eligibility and coverage details
- Interpret and apply policy terms and conditions to claims
- Communicate with healthcare providers and policyholders to gather necessary information
- Identify and investigate potential fraud or discrepancies
- Ensure compliance with regulatory and company guidelines
- Calculate reimbursement amounts based on policy coverage and medical coding
- Document claim decisions and maintain accurate records
- Collaborate with other departments to resolve complex claims issues
- Provide feedback and recommendations for process improvements
Requirements
Text copied to clipboard!- Bachelor’s degree or equivalent experience in healthcare, insurance, or related field
- Strong knowledge of medical terminology and coding (ICD, CPT)
- Experience in medical claims processing or insurance assessment
- Familiarity with healthcare regulations such as HIPAA
- Excellent analytical and decision-making skills
- Proficiency in claims management software and Microsoft Office
- Strong written and verbal communication skills
- Attention to detail and high level of accuracy
- Ability to manage multiple tasks and meet deadlines
- Customer service orientation and problem-solving abilities
Potential interview questions
Text copied to clipboard!- Do you have experience processing medical insurance claims?
- Are you familiar with ICD and CPT coding systems?
- How do you ensure accuracy when reviewing complex claims?
- Can you describe a time you identified a fraudulent claim?
- What claims management software have you used?
- How do you stay updated on healthcare regulations?
- Describe your approach to handling claim disputes.
- What steps do you take to verify patient eligibility?
- How do you prioritize tasks when managing multiple claims?
- Have you worked with cross-functional teams to resolve claims issues?
