Claims Processor

As a Health Claims Specialist, you will play a critical role in ensuring timely and accurate processing of medical claims. This requires meticulous attention to detail, industry knowledge, and effective communication skills.About the Role:This position involves reviewing and analyzing medical claims for accuracy, completeness, and compliance with insurance policies and regulatory requirements.You will verify patient eligibility, insurance coverage, and benefits to determine claim validity and appropriate reimbursement.Maintaining up-to-date knowledge of healthcare regulations and industry trends is essential for this role.You will work closely with billing, audit, and other teams to ensure seamless collaboration and efficient operations.The ideal candidate will possess excellent analytical and problem-solving skills, with the ability to adapt to changing circumstances and priorities. Strong customer service skills are also essential for building trust and rapport with policyholders and healthcare providers.Responsibilities:Review and analyze medical claims for accuracy and completenessVerify patient eligibility and insurance coverageAssign medical codes according to industry standardsAdjudicate claims based on established criteriaProcess claims promptly and accurately using designated platformsInvestigate and resolve discrepancies and claims denials through effective communicationRequirements:Strong analytical and problem-solving skillsExcellent customer service skillsMaintaining up-to-date knowledge of healthcare regulationsAbility to work in a fast-paced environment