Claim representative
Core
Process medical insurance claims for members and providers, ensuring accurate data input, eligibility assessment, and compliance with benefit policies.
Role type
Claims representative (medical insurance)
Builds
Claims processing workflows and provider reimbursement records
Domain
Healthcare insurance
Required skills
Claims processing, Medical terminology, Data entry, Policy interpretation, Microsoft Office, Communication
Preferred skills
International company experience, Insurance experience, Cost management awareness
Responsibilities
Process claims from members and providers, Assess eligibility within policy boundaries, Maintain files for authorizations and reports, Monitor high-cost claims, Collaborate with cross-functional teams, Meet Service Level Agreement requirements