Claims Processor
Job Summary
Review and process medical claims submitted by members or healthcare providers while verifying eligibility and benefits coverage. Ensure documents are complete and apply appropriate coding and benefits computation based on plan and HMO rules. Candidates with a relevant degree and 1-2 years of experience in medical claims processing are preferred.
Responsibilities
- Review and process medical claims
- Check documents for completeness
- Verify member eligibility and benefits
- Apply coding and benefits computation
Required Skills
- Medical claims processing
- Medical billing and reimbursement
- HMO procedures familiarity
- Administrative support
Job Details
Review and process medical claims submitted by members or healthcare providers.
Check documents for completeness, including medical abstracts, itemized statements, and official receipts.
Verify member eligibility, benefits coverage, and policy limits.
Apply appropriate coding and benefits computation based on the member’s plan and HMO rules.
Bachelor’s degree in Business administration, Healthcare Management, Nursing, or a related field is preferred.
A diploma in medical, healthcare, or business-related field may be considered.
1-2 years of relevant experience in medical claims processing or administrative support in healthcare, hospitals, clinics, or insurance/HMO industries.
Familiarity with medical billing and reimbursement processes.
Experience working with HMO procedures and healthcare provider networks is a plus.