Medical Claims Processor Job Description


Medical billing and coding are skills that a medical claims processor possesses. Mastery of current procedural terminology and worldwide illness classification coding systems are required for this post. They are in charge of handling claims forms, allocating premiums and deductibles, and pursuing adjudication processes to ensure that claims are paid properly. They contact insurance providers and beneficiaries, as well as fill out claim forms and other paperwork. They are in charge of overseeing claims and validating the information found in them. Claims processors keep track of insurance plans and claim details in computer systems and calculate claim payments while determining policy coverage. Claims processors must guarantee that all claim payments are processed following federal, state, and company requirements and procedures. Claims processors must have at least two years of claims processing or related experience, as well as a thorough knowledge of the insurance sector and applicable federal and state rules.

Medical Claim Processor Job Titles:

  • Medical Claim Processor
  • Medi Claim Processor

Medical Claim Processor Job Summary:

To join our insurance team, we’re seeking a detail-oriented claims handler. You’ll be in charge of filling out claim forms, checking data, and communicating with agencies and claimants. You’ll also be responsible for answering customer questions, reviewing policies, determining coverage, calculating claim amounts, and payment processing. You will be responsible for reviewing and evaluating patient files to verify that they were approved for routine treatment by the insurance provider. In a database system, you must keep track of insurance contracts and claim details. You should calculate claim costs and execute claim payouts after verifying policy coverage. You’ll need good organizational and interpersonal abilities to succeed as a claims processor. You must also be able to operate under duress and with strong attention to detail while performing a variety of clerical work.

Medical Claim Processor Job Responsibilities and Duties:

  • Handle a collection of various types of claims properly.
  • To guarantee full records, review, and update case files.
  • React to internal and external requests for information about disputes promptly.
  • Evaluate, draught, and write letters, documents, and files.
  • Inform claimant, customer, and relevant medical reference of claim action progress.
  • Identifies and resolves communication issues, as well as takes corrective action when necessary.
  • Interact with customers and respond to their questions about lien/bond claim notices delivered to house owners, building contractors, and subcontractors.
  • Prepare claim statements in collaboration with claim adjusters.
  • Monitor programs to ensure that state-mandated contact dates are followed and that the case is resolved quickly and appropriately.
  • Help and support the update of reinsurance data and services.

Medical Claim Processor Job Skills and Qualification:

  • Bachelor’s degree in business or computer science
  • At least two years of claims processing or equivalent experience is required.
  • A solid understanding of the insurance sector, as well as related federal and state rules, is required.
  • Computer savvy and adept in MS Office.
  • Excellent decision-making and critical analysis abilities.
  • Managerial and organizing skills are essential.
  • Excellent customer service abilities.
  • Capacity to work under time constraints.
  • Display good critical reasoning and problem-solving abilities.
  • Showed meticulous attention to detail.

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