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Claims Specialists

Vedanayagam Hospital

TalentMD Healthcare Jobs
Urgently Required

Claims Specialists

Experience :  1 to 5 years

No of vacancies :  1

Job Description: Claims Specialists in the healthcare ecosystem play a critical role in managing and processing insurance claims to ensure timely and accurate reimbursement for healthcare services. They navigate complex insurance policy guidelines, liaise with insurance companies, healthcare providers, and patients to resolve claims issues, and ensure compliance with healthcare regulations.

Key Responsibilities: Claims Processing: Review and process medical claims according to insurance policies and healthcare regulations.
Verification: Verify patient eligibility, insurance details, and ensure that services provided are covered under the patient’s insurance plan.
Documentation: Maintain accurate records of all claims, including submissions, denials, appeals, and payments.
Resolution of Disputes: Investigate and resolve discrepancies or disputes related to insurance claims, working closely with insurance providers and healthcare professionals.
Compliance: Ensure all claims processing activities comply with relevant laws, regulations, and guidelines.
Reporting: Prepare and submit reports on the status of claims, denials, and appeals, highlighting any issues that require attention.
Customer Service: Provide support to patients regarding their insurance claims, explaining the claims process, and addressing any concerns.

Education Qualifications: Education: High school diploma required; bachelor’s degree in finance, healthcare administration, or related field preferred.
Experience: Previous experience in healthcare billing, insurance claims, or a related field is highly beneficial.
Certifications: Certifications like Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS) can be advantageous

Key Attributes: Attention to Detail: Precision in reviewing claims and identifying discrepancies or missing information.
Analytical Skills: Ability to analyze complex insurance policies and healthcare regulations.
Communication Skills: Clear and effective communication with insurance companies, healthcare providers, and patients.
Problem-Solving: Quick and effective resolution of claims issues and disputes.
Organizational Skills: Ability to manage and prioritize a high volume of claims efficiently.

About the Role: Coordinator: Acts as a liaison between healthcare providers, patients, and insurance companies to ensure smooth processing of claims.
Advisor: Provides guidance to patients on the claims process and helps them understand their insurance benefits.
Auditor: Reviews processed claims to ensure accuracy and compliance with policies and regulations.
Trainer: Educates new staff on the claims processing system, policies, and best practices.
Analyst: Analyzes claims data to identify trends, issues, and opportunities for improving the claims management process.
Claims Specialists are vital to the financial health of healthcare organizations, ensuring that services rendered are appropriately compensated through efficient and accurate claims processing. They contribute to the overall satisfaction of patients by providing clarity and support throughout the claims process.