Medical claims processor job description
This post includes 3 parts: duties list, job qualification and job description writing tips for Medical claims processor in details. A compl...
https://teachingtips247.blogspot.com/2013/07/medical-claims-processor-job-description.html
This post includes 3 parts: duties list, job qualification and job description writing tips for Medical claims processor in details. A complete job description concludes Medical claims processor key duties/responsibilities, Medical claims processor job qualifications (knowledge, education, skills, abilities, experience…KSA model) and other ones such as daily tasks, key activities, key/core competencies, job functions/purpose…
I. List of Medical claims processor duties:
1. Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
2. Input enrollment, eligibility, processing codes (CPT4, ICD10, etc.) as required
3. Pay and process claims within designated authority level.
4. Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
5. Contact and/or interview claimants, doctors, medical specialists, or employers to get additional information.
6. Report overpayments, underpayments, and other irregularities.
7. Communicate with reinsurance to obtain information necessary for processing claims.
8. Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
9. Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
10. Develop the processes and procedures to enroll and provide caring service to members and their families
11. Build strong relationships proactively identifying the needs of the member, and satisfying the member in an appropriate and timely manner.
12. Liaison with health advisory team, provider community, and sales team to ensure a positive client experience
13. Responds and manages all inquiries (call and email) and own resolution for members and providers.
14. Maintain client records and service history.
15. Ability to effectively problem-solve issues to resolution particularly dealing with a demanding elite international clientele.
II. List of Medical claims processor qualifications
1. Minimum of five years of experience in healthcare insurance products and service operations, preferably international.
2. Three plus years work experience in / enrollment, claims, client service/ /account services/sales, or other areas requiring significant client interaction
3. Bachelor's degree in international business, insurance, or other appropriate professional degree required or equivalent work experience.
4. Demonstrated strength and understanding of client expectations and "sense of urgency" resulting in the ability to exceed client expectations.
5. Strong verbal/written communication, organizational and time management skills
6. Comfortable working with prominent and affluent individuals including international physicians, executives, and business entrepreneurs.
7. Proficiency in MS Office required; Claims, CRM databases preferred
III. Tips to write job description
1. Too-long job description:
Looking at a too-long job description can frighten the candidates off and drive the away. A job description, no matter how important the job is, should not be included in more than 3 pages. If one focuses on too many things at a time, he shall definitely lose focus on the main items and get overwhelmed by the remaining; So, keep it concisely.
2. Too-short job description:
While too-long can be a problem, too-short is more a problem. It will ruin the meaning of the job description. A too-short one means it lacks necessary details and therefore, the candidate will not be able to understand while reading it.
3. Listing unnecessary functions or job duties:
Just classifying these into the “others” category will save you a lot of effort and space. On the other hand, the job description will become more dilute and easy to be neglected.
4. Key functions
Not listing key functions as required for the job can be a fatal mistake to a job description.
5. Grammar and spelling
Poor grammar and having spelling errors can ruin the job description, too. Never think that as you are the employer, you may have the right to make grammar or spelling errors while requires other not to. A job description with such errors is easily to be mistaken as a fake or ghost ads; as a result, the candidate will turn away from it.
6. Not specific enough:
Be specific and concise; if you don’t address the specific, then what the job description is for. It is for the candidate to understand just exactly what he needs to do or needs to have. Lacking details can confuse the candidates very well.
7. Not having the job description reviewed by others:
This is also a common mistake. One may be subject to bias, but more than one, especially with the help of those external advisor, the job description can be more perfect.
8. Using buzzwords or abbreviations:
In fact, it is not necessary at all to use such in a job description.
9. Using slang or legal words:
Just use common wording to communicate with others and don’t do anything extraordinarily.
10. Not updating the job description:
The same job may require different duties and responsibilities in different times, so, you cannot use the same job description for 2 different times.
