Medical Claims Specialist
Job Summary
The Medical Claims Specialist will harmonize, digitize, and automate claims workflows across all clinics. This role involves managing data related to fee schedules and insurance arrangements while ensuring compliance and fast turnaround times. You will act as a key liaison between patients, healthcare providers, and insurance companies to optimize the healthcare delivery experience.
Responsibilities
- Automate and manage claims workflows
- Monitor claims cycle and compliance
- Liaise between patients, providers, and payors
- Generate reports and train staff
Required Skills
- Diploma or higher
- 3+ years healthcare claims experience
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.
Requirements:
- Min Diploma or higher educational qualification.
- Min 3 years of experience in claims in Healthcare Industry.