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