Adjudication Claim Examiner Job Description
The Adjudication Claim Examiner plays a crucial role in the insurance industry by ensuring accurate and timely processing of claims. They work closely with insurance providers, healthcare professionals, and policyholders to gather and verify necessary documentation, determine eligibility, and make claim reimbursement decisions.
Responsibilities
- Review and evaluate insurance claims for accuracy and completeness
- Verify policyholder information and eligibility for claim reimbursement
- Investigate and gather necessary documentation to support claim decisions
- Collaborate with healthcare professionals and insurance providers to resolve claim issues
- Adhere to company policies and procedures to ensure compliance
- Maintain accurate and detailed records of claim activities
- Communicate with policyholders, healthcare professionals, and insurance providers to provide claim status updates and resolve inquiries
Qualifications
- Previous experience in insurance claims processing or medical billing
- Knowledge of medical terminology and coding systems
- Strong attention to detail and analytical skills
- Excellent communication and interpersonal skills
- Ability to work independently and prioritize tasks
- Proficient in using computer systems and software
- Familiarity with insurance policies and regulations
Skills
- Knowledge of medical coding systems (e.g. CPT, ICD-10)
- Understanding of insurance policies and regulations
- Attention to detail
- Analytical skills
- Communication skills
- Interpersonal skills
- Organizational skills
- Time management
- Computer skills
- Problem-solving skills