What are the responsibilities and job description for the Claims Processing Specialist position at FIRSTENROLL LLC?
Location: Alpharetta
In Office
Job Overview:
A Healthcare Claims Processing Specialist plays a crucial role in the insurance industry, ensuring that claims are handled efficiently and accurately. Here’s a detailed description of the role:
Claims Processing Specialist Responsibilities:
- Review and Evaluate Claims: Assess all types of healthcare insurance claims for accuracy and completeness.
- Investigate Claims: Analyze details to determine the level of liability, often involving communication with policyholders, claimants, and healthcare providers.
- Adjudicate Based on Plan Documentation: Work with plan documentation to adjudicate based on plan summary of coverages.
- Documentation: Maintain detailed records of all claim activities for review and auditing purposes.
- Compliance: Ensure all actions comply with company policies and legal requirements.
- Customer Service: Provide high levels of customer service by answering questions and providing information to all parties involved in the claims process.
- Fraud Detection: Identify and investigate potential fraudulent claims.
- Continuous Learning: Stay updated with changes in regulations, best practices, and industry trends.
Qualifications:
- Experience: Proven experience in a similar role within the healthcare insurance industry.
- Skills: Strong analytical, problem-solving, and negotiation skills. Detail-orientation a must. Excellent communication and customer service abilities.
- Technical Proficiency: Familiarity with insurance software and digital claim processing tools.
