Insurance Verification

Job Purpose:

Serves medical insurance customers by determining insurance coverage; examining and resolving medical claims; documenting actions; maintaining quality customer services; ensuring legal compliance.



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.



Skills/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