Health Insurance Claims Specialist

What role you will play in team: You'll be a vital part of our team, ensuring timely and accurate processing of health insurance claims, providing excellent service to our policyholders and contributing to a smooth claims process.

What you will do: You will be responsible for verifying eligibility, assessing medical necessity, processing payments and communicating with providers and policyholders.

Key responsibility:

• Verify policyholder eligibility and benefits.
• Review medical documentation to assess the medical necessity of services.
• Determine the appropriate payment amounts for claims.
• Process payments to providers and policyholders.
• Maintain accurate records and documentation.
  
• Communicate with providers and policyholders regarding claim status.
• Identify and report any suspected fraudulent activities.
• Stay updated on changes in regulations and industry best practices.

Required Qualification and Skills:

• Bachelor's degree in a related field (Healthcare Administration, etc.).
• Strong understanding of health insurance terminology and procedures.
• Excellent communication and customer service skills.
• Proficient in using claims processing software.

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  Analytical and detail-oriented approach.
• Knowledge of medical coding (CPT, ICD) preferred.

Benefits Included:

• Competitive salary and benefits package.
• Opportunities for professional growth and development.
• Collaborative and supportive work environment.
• Comprehensive training on health insurance claims processing.

A Day in the Life: A typical day involves reviewing medical records, verifying eligibility, processing claims, communicating with healthcare providers and policyholders, and ensuring accuracy and compliance.