Leistungs-Sachbearbeiter Krankenversicherung (m/w/d)
Core
Process and decide on medical insurance claims (outpatient, inpatient, dental) by evaluating medical necessity and financial details based on GOÄ and insurance terms.
Role type
Claims adjudicator (medical insurance)
Builds
Insurance claim payments and denials for policyholders
Domain
Health insurance / Medical billing
Required skills
Medical billing expertise, GOÄ fee schedule knowledge, Insurance contract interpretation, Medical necessity assessment, Claims processing, Customer service communication
Preferred skills
Experience with large-scale billing systems, MS Teams, Outlook, Regulatory change management
Technologies
Large-scale billing systems, MS Teams, Outlook
Responsibilities
Review and approve/reject medical invoices, Evaluate medical necessity for treatment plans, Handle complex cases like accident claims and refunds, Communicate claim decisions to policyholders, Adapt to regulatory changes like GOÄ updates, Collaborate with medical management and doctors
Seniority
Mid-level, hands-on IC