100 Broadway Lane
New Parkland, CA, 91010
Cell: (555) 987-1234
Detail oriented Medical Claims Examiner with the document review and policy skills to efficiently and accurately complete claims examinations. Skilled at reviewing policy to determine coverage, maintaining and retrieving patient records and information, and reviewing and applying claims policy. Specializes at verifying and validating data.
Medical Claims Examiner, February 2009 to Present
Central California Hospital – New Cityland, CA
- Resolved medical claims by conducting document examinations and reviews
- Organized, processed and authorized claims payments, negotiated coverage rates with claim filers
- Maintained and organized claims documentation including financial, account and medical information
Medical Claims Examiner, March 2004 to January 2009
Aeros Medical – New Cityland, CA
- Monitored, updated and implemented guidelines and procedures for the processing of claims and the applicable coverage
- Reviewed financial documents, account statements, and claims payments to determine coverage
- Negotiated with clients individually to settle claims
Medical Claims Examiner, October 2000 to April 2004
Cityland Medical – New Cityland, CA
- Reviewed claims policies and procedures to determine applicable coverage for filed claims
- Inputted claims information, payments and reserves, organized and retrieved patient information
- Coordinated with clients, medical insurers and accountants to retrieve and process claims payments
2000 Bachelor of Science, Accounting
University of Southern California – Los Angeles, CA
This medical claims specialist/examiner sample job description can assist in your creating a job application that will attract job candidates who are qualified for the job. Feel free to revise this job description to meet your specific job duties and job requirements.
Medical Claims Specialist Examiner Job Responsibilities:
Serves medical insurance customers by determining insurance coverage; examining and resolving medical claims; documenting actions; maintaining quality customer services; ensuring legal compliance.
Medical Claims Specialist Examiner Job Duties:
- Determines covered medical insurance losses by studying provisions of policy or certificate.
- Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims.
- Documents medical claims actions by completing forms, reports, logs, and records.
- Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter.
- Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.
- Maintains quality customer services by following customer service practices; responding to customer inquiries.
- Provides legal support by assembling documentation for settlement action.
- Protects operations by keeping claims information confidential.
- Prepares reports by collecting, analyzing, and summarizing information.
- Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
- Accomplishes organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
Medical Claims Specialist Examiner Skills and Qualifications:
Claims Adjustment, Financial Software, Documentation Skills, Data Entry Skills, Analyzing Information , Problem Solving, Verbal Communication, Customer Focus, FDA Health Regulations, General Math Skills, Statistical Analysis
Employers: Post a job in minutes to reach candidates everywhere.
Job Seekers: Search Medical Claims Specialist Examiner Jobs and apply on Monster now.
Find out more about how to hire: