We are looking for a detail-oriented Claims Representative to join our claims team. You will be responsible for verifying information and corresponding with agents and beneficiaries. You will also handle client inquiries, review policies, determine coverage, calculate claim amounts, and process payments.
To be successful as a claim’s processor, you should have excellent organizational and interpersonal skills. You should also be able to work under pressure and perform a range of clerical functions with great attention to detail.

Main Duties / Responsibilities

• A medical claims processor validates the information on all medical claims from patients seeking payment from the company.
• Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information.
• In addition, a processor must keep meticulous records of claims and follow up on lapsed cases.
• Medical claims processors are expected to have an extensive knowledge of medical terminology, as well as experience using a computer.
• Recording and maintaining insurance policy and claims information in a database system.
• Determining policy coverage and calculating claim amounts.
• Processing claims payments.
• Answering queries related to Policy coverage criteria and guidelines.
• Complying with federal, state, and company regulations and policies.
• Since medical claims processors must approve or deny payment to doctors, it is vital that they know how to correctly read and assess medical documents.
• Good communication skills are necessary to converse with doctors’ offices or insurance companies if there is a problem with the claim.
• Performing other clerical tasks, as required.

Claims Processor Requirements:

• A medical-related Diploma or Degree qualification is required.
• At least 1 year as a medical claims processor.
• Familiarity with medical terminologies and understanding of CPT codes and ICD-9 codes.
• Working knowledge of the insurance industry and relevant federal and state regulations.
• Computer literate and proficient in MS Office.
• Excellent critical thinking and decision-making skills.
• Good administrative and organizational skills.
• Strong customer service skills.
• Ability to work under pressure.
• High attention to details.