Medical Claims Specialist
Job Summary
The Medical Claims Specialist will harmonize and automate claims workflows across clinics. The role involves managing billing data, tracking the claims cycle, and ensuring regulatory compliance. You will also act as a liaison between patients, providers, and insurance companies to optimize healthcare delivery.
Responsibilities
- Automate claims workflows
- Manage billing and insurance data
- Track claims cycle accuracy
- Bridge communication between parties
- Train staff on billing processes
Required Skills
- Min 3 years Healthcare claims experience
- Diploma or higher qualification
- Knowledge of insurance products
- Data analysis and reporting
Job Details
Responsibilities:
- Harmonizing, digitizing, and automating claims workflows across all clinics.
- Managing data related to fee schedules, billing, pricing, and pre-agreed insurance working arrangements.
- Tracking and monitoring the entire claims cycle to ensure accuracy, compliance, and fast turnaround times.
- Executing initiatives that cut out inefficiencies in the healthcare delivery process.
- Acting as a bridge between patients, healthcare providers, and payors (e.g., insurance companies and TPAs) to improve the experience for all parties.
- Generating monthly statistical reports, tracking costs and quality, and benchmarking for management decisions.
- Training internal medical and clinic staff on insurance products and billing processes so they can better assist patients.
- Ensuring that claims submissions comply with both internal guidelines and external regulatory and statutory requirements.
Requirement:
- Min Diploma or higher educational qualification.
- Min 3 years of experience in claims in Healthcare Industry.