Claim Benefit Specialist- Franklin, TN.
Core
Reviews and processes medical benefits claims submitted by healthcare providers, verifying policy coverage and ensuring accurate reimbursement.
Role type
Claims processing specialist
Builds
Medical claims processing workflow
Domain
Health insurance / Medical billing
Required skills
Medical coding knowledge, Claims documentation review, Policy coverage verification, Regulatory compliance, Data analysis, Report generation
Preferred skills
Medical claim processing experience, Production environment experience, Multi-tasking, Communication skills
Technologies
Claims management systems, Coding guidelines
Responsibilities
Process benefits claims for accuracy and compliance, Determine eligibility and coverage based on patient plans, Assess claims for medical necessity and documentation, Document claim information with appropriate codes, Investigate claims requiring validation, Communicate with providers and patients to resolve discrepancies, Analyze claims data to identify trends and inform process improvements
Seniority
Entry-level, individual contributor