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Health Insurance Claim Expert
3 weeks ago
Our organization is seeking a highly skilled and experienced Senior Claims Specialist to join our team. This role involves validating and processing health insurance claims, ensuring accurate data entry, and supporting claims review for completeness and policy adherence.
Key Responsibilities:- Validate and process health insurance claims according to industry guidelines.
- Ensure accurate documentation and data entry in the claims management system.
- Review claims for completeness and policy compliance.
- Coordinate with internal departments to gather missing information.
- Identify and flag discrepancies for further review.
- Maintain confidentiality and adhere to data protection standards.
- Respond to policyholders inquiries regarding claim status and documentation.
- Ensure claims are processed timely to meet service level agreements.
- Generate reports for internal tracking and audits.
- Stay updated on claims procedures and regulatory changes.
- Participate in training sessions related to claims systems and regulations.
Requirements:
- Bachelor's degree in Insurance, Business Administration, Healthcare Management, or related field.
- Basic understanding of health insurance products and claims lifecycle.
- Proficiency in Microsoft Office and claims management software.
- Strong attention to detail and organizational skills.
- Fluency in English (spoken, read, and written).
