Medical Claims Examiner

Job Description

As a Medical Claims Examiner at Healthcare Solutions Ltd., you will be pivotal in reviewing and processing medical insurance claims. Your expertise will ensure claims accuracy, adherence to policies, and facilitate smooth interactions between healthcare providers and policyholders.

Responsibilities

• Assess medical claims for accuracy, completeness, and adherence to established guidelines.
• Validate claims and make decisions regarding benefits coverage.
• Examine medical records, invoices, and other necessary documentation.
• Liaise with healthcare providers and internal teams to gather required information.
• Resolve claims-related disputes and issues efficiently.
• Ensure accurate and timely documentation of claims processing.
• Comply with all regulatory requirements and standards in the industry.
• Participate in identifying and implementing process improvements.
• Keep abreast of current insurance policies, industry trends, and coding practices.

Requirements

Education

• High school diploma or equivalent
• Certification in medical billing and coding is favourable.

Experience

• 2+ years in medical claims handling or a similar role.

Technical Skills

• Proficiency in medical claims processing software
• Knowledge of billing procedures

Soft Skills

• Attention to detail
• Customer service orientation

Advantageous

• Certifications in healthcare administration: Experience with claims management systems or software.

Benefits

• Comprehensive health insurance
• Employee training and development opportunities
• Flexible working hours
• Discounts on healthcare services

Company Culture

• Innovation: We embrace change and encourage innovative approaches to improving processes.
• Work-Life Balance: We prioritize our employees' wellbeing through flexible working arrangements.
• Respect and Integrity: Our team operates on principles of respect, integrity, and trust.