Responsibilities:
We are seeking a detail-oriented Healthcare Claims Specialist to join our team. In this role, you will be responsible for reviewing and processing healthcare claims, ensuring accuracy and efficiency. You will collaborate with healthcare providers, patients, and insurance companies to verify claim validity and determine appropriate coverage. Your responsibilities include, but not limited to, as follows:
· Claims Processing and Review: Process and review healthcare claims, including pre-authorization requests
· Claim Verification: Verify claim information for accuracy and identify potential discrepancies or errors
· Coverage Determination: Determine appropriate coverage and benefits based on policy guidelines and medical necessity
· Stakeholder Communication: Communicate effectively with healthcare providers, patients, and insurance companies to address inquiries and provide updates
· Regulatory Compliance: Stay current with insurance regulations and industry trends to ensure compliance
· Record Keeping: Maintain accurate and organized records and documentation related to claims processing.
Requirements:
· Diploma/ Bachelor's degree in a related field or equivalent experience
· Minimum 3 years experience in healthcare, insurance, operations or a related field
· Proficiency in relevant software applications
· Strong analytical and problem-solving skills
· Excellent attention to detail
· Ability to work independently and as part of a team
· Strong communication and interpersonal skills
· Proficient in Microsoft Office Application for reports and preparation of presentation slides
· Confident to engage stakeholders of different levels
· Team player to support management and reportees
