Claims Adjuster, Examiner, and Investigator

Job Description

As a Claims Adjuster, Examiner, and Investigator, you will play a crucial role in reviewing and assessing health insurance claims. You will verify policy details and coverage while determining the validity of claims based on established terms and conditions. Collaborating with healthcare professionals, you'll gather and interpret complex medical information to provide exceptional support to our clients.

Responsibilities

• Investigate and analyze incoming claims to validate their authenticity.
• Work closely with healthcare providers to gather additional claim information.
• Determine appropriate payments for approved claims based on policy terms.
• Support customers by explaining the claims process and answering queries.
• Monitor claims processing for compliance with company policies.
• Train junior staff on claims assessment procedures as required.
• Improve current processes by suggesting enhancements based on findings.
• Participate in audits of claims for quality assurance.

Requirements

Education

• Bachelor's degree in Health Administration, Nursing, or related field
• Registered Nurse (RN) license preferred
• Health Insurance certification preferred

Experience

• Minimum of 2 years' experience in medical claims processing.

Technical Skills

• Claims Processing Software
• Microsoft Office Suite

Soft Skills

• Strong Problem-Solving Skills
• Ability to Work Independently

Languages

• English: Fluent

Advantageous

• Experience working with healthcare providers: Understanding of the healthcare provider landscape and processes.
• Familiarity with health insurance policies and regulations: Knowledge of the regulatory landscape affecting health insurance.

Benefits

• Comprehensive health, dental, and vision coverage.
• Performance bonuses and rewards.
• Support for continuous education and training.
• Paid time off and holiday leave.

Company Culture

• Innovation and Adaptation: We embrace innovation and seek to adapt to the ever-changing healthcare landscape.
• Professional Growth: We support our employees’ professional growth through training and mentorship.
• Inclusive Environment: Our team is diverse and inclusive, welcoming talents from all backgrounds.