Medical Insurance Claims Processor

Job Description

We are currently seeking a detail-oriented Medical Insurance Claims Processor. This role involves processing and adjudicating medical claims, verifying their accuracy, and ensuring compliance with all policy provisions. The ideal candidate will have a solid understanding of medical terminology and experience in claims processing.

Responsibilities

• Evaluate and process claims for medical necessity and policy compliance.
• Collaborate with healthcare professionals to verify claim information.
• Report on claims processing metrics and performance indicators.
• Train new staff members on claims processing procedures.
• Help design training materials for future staff development.

Advantageous

• Experience working with healthcare providers and third-party administrators: Understanding of interactions and relationships with medical practitioners and insurers.
• Knowledge of ICD-10, CPT, and HCPCS coding: Familiarity with coding standards critical to claims processing.

Benefits

• Full medical aid coverage.
• Generous leave policies.
• Continuous professional development opportunities.
• Performance bonuses based on targets.

Company Culture

• Innovation: We prioritize innovative solutions that meet the evolving needs of our clients.
• Growth Environment: Employees are provided with opportunities for personal and professional growth.
• Community Engagement: We believe in giving back to the community and supporting local initiatives.