Medical Insurance Claims Processor

Job Description

As a Medical Insurance Claims Processor, you will play a key role in accurately processing and managing medical insurance claims. Your responsibilities will include reviewing claims for accuracy, ensuring policy compliance, and verifying medical records.

Responsibilities

• Assess medical claims for adherence to coverage policies and guidelines.
• Ensure all necessary documentation is complete and accurate.
• Provide feedback to claimants regarding the status of claims.
• Document all claims decisions and maintain thorough records.
• Liaise with medical professionals to clarify claims information.
• Evaluate claims for potential fraud or discrepancies.
• Prepare reports on claims processed and outcomes for management review.
• Support training and onboarding of new team members in claims processing protocols.

Requirements

Education

• High school diploma/GED required
• Additional certifications in medical coding or insurance claims processing preferred

Experience

• 1-3 years of prior experience in medical insurance claims processing or a related field

Technical Skills

• Attention to detail
• Knowledge of medical coding and terminology
• Proficiency in using relevant software platforms

Soft Skills

• Analytical thinking
• Communication skills

Certifications

• Medical Coding Certification
• Insurance Claims Processing Certification

Languages

• English: Fluent

Advantageous

• Experience with specific claim processing software: Hands-on experience managing claims in EPIC or Cerner.
• Familiarity with UK insurance regulations: Knowledge of current insurance standards and compliance regulations.

Benefits

• Competitive salary based on experience and qualifications.
• Annual leave and sick leave.
• Opportunities for professional development and training.
• Health and wellness benefits.

Company Culture

• Team-Oriented Environment: We promote a collaborative atmosphere where everyone's contributions are valued.
• Continuous Improvement: Our focus is on ongoing development and improving efficiencies in all processes.
• Commitment to Diversity: We are committed to building a diverse workforce that reflects the communities we serve.