Medical Claim Examiner
Current- Ensure accurate medical claims investigation by gathering information from insured and healthcare providers.
- Ensure medical claims are valid and settlement are made according to the insurance policy.
- Establish and maintain appropriate reserves in accordance with department policies and procedures.
- Resolve medical claims by approving or denying documentation, calculate benefits due, authorize payments, or compose a denial letter
- Determine the eligible amount for reimbursement and issue payment to insured and healthcare providers