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Title
Text copied to clipboard!Health Insurance Claims Adjuster
Description
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We are looking for a dedicated Health Insurance Claims Adjuster to join our team. In this role, you will be responsible for reviewing and processing health insurance claims to ensure they are handled accurately and efficiently. You will analyze claims to determine the extent of the insurance company's liability, interpret policy coverage, and communicate with policyholders, medical professionals, and other stakeholders to gather necessary information. The ideal candidate will have a keen eye for detail, strong analytical skills, and the ability to work independently while maintaining a high level of accuracy. You will play a crucial role in ensuring that claims are processed in a timely manner, adhering to company policies and regulatory requirements. Your expertise will help maintain the integrity of our claims process and provide excellent service to our clients.
Responsibilities
Text copied to clipboard!- Review and process health insurance claims accurately.
- Analyze claims to determine coverage and liability.
- Communicate with policyholders and medical professionals.
- Ensure compliance with company policies and regulations.
- Maintain detailed records of claims and decisions.
- Collaborate with other departments to resolve complex cases.
- Provide excellent customer service to claimants.
- Identify and report fraudulent claims.
Requirements
Text copied to clipboard!- Bachelor's degree in a related field or equivalent experience.
- Previous experience in health insurance claims processing.
- Strong analytical and problem-solving skills.
- Excellent communication and interpersonal skills.
- Attention to detail and high level of accuracy.
- Ability to work independently and manage time effectively.
- Proficiency in claims management software.
- Knowledge of health insurance policies and regulations.
Potential interview questions
Text copied to clipboard!- Can you describe your experience with health insurance claims processing?
- How do you ensure accuracy and compliance in your work?
- What strategies do you use to handle complex or disputed claims?
- How do you prioritize tasks when managing multiple claims?
- Can you provide an example of a time you identified a fraudulent claim?
