Medical Claims Offic....
Medical Claims Officer
Posted on :
21-04-2024
Employer Active
1 Vacancy
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Job Description
Req ID : 549429
- Determines covered medical insurance losses by studying provisions of policy or certificate.
- Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims.
- Documents medical claims actions by completing forms, reports, logs, and records.
- Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter.
- Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.
- Maintains quality customer services by following customer service practices; responding to customer inquiries.
- Provides legal support by assembling documentation for settlement action.
- Protects operations by keeping claims information confidential.
- Prepares reports by collecting, analyzing, and summarizing information.
- Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
- Accomplishes organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
Employment Type
Full Time
Company Industry
Department / Functional Area
Doctor / Nurse / Paramedics / Hospital Technicians / Medical Research
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