Insurance Claims Specialist
Core
Review, evaluate, and process medical insurance claims with high accuracy, ensuring timely adjudication and quality service.
Role type
Claims Specialist (Medical/Healthcare)
Builds
Processed insurance claims and accurate medical data entries
Domain
Healthcare administration and insurance
Deliverable
client delivery
Required skills
Medical terminology, claims processing, data entry, regulatory compliance, medical record analysis, diagnostic code interpretation, system documentation, stakeholder communication
Preferred skills
U.S. healthcare system familiarity, insurance terminology knowledge, analytical thinking, critical thinking
Technologies
Claims processing systems, Microsoft Office
Responsibilities
Review and process incoming claims per policies; Enter claimant insurance data; Analyze claim info and medical records for eligibility; Identify discrepancies and follow up with providers/claimants; Interpret clinical notes and diagnostic codes; Document claim actions; Collaborate with QA and Medical Review units; Escalate high-risk claims; Respond to status queries; Follow up on pending/denied claims; Support process improvements