Claims Clerk I reviews insurance claim forms and supporting documents for completeness and accuracy and obtains missing information as necessary. Inputs claim information into system for processing. Being a Claims Clerk I verifies coverage eligibility. Calculates settlement amounts according to guidelines. Additionally, Claims Clerk I processes routine claim payments. Requires a high school diploma or equivalent. Typically reports to a supervisor. The Claims Clerk I works under the close direction of senior personnel in the functional area. Possesses a moderate understanding of general aspects of the job. May require 0-1 year of general work experience.
Claims Clerk II reviews insurance claim forms and supporting documents for completeness and accuracy and obtains missing information as necessary. Inputs claim information into system for processing. Being a Claims Clerk II verifies coverage eligibility. Calculates settlement amounts according to guidelines. Additionally, Claims Clerk II processes routine claim payments. Requires a high school diploma or equivalent. Typically reports to a supervisor. The Claims Clerk II works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Claims Clerk II typically requires 1-3 years of related experience.
Claims Clerk III reviews insurance claim forms and supporting documents for completeness and accuracy and obtains missing information as necessary. Inputs claim information into system for processing. Being a Claims Clerk III verifies coverage eligibility. Calculates settlement amounts according to guidelines. Additionally, Claims Clerk III processes routine claim payments. Requires a high school diploma or equivalent. Typically reports to a supervisor. The Claims Clerk III works independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. To be a Claims Clerk III typically requires 3-5 years of related experience.
The Claims Reimbursement Clerk reviews and verifies policy details, coverage, and completeness of claim submissions. Submits claims to third-party payers, ensuring accurate and timely payment for services. Being a Claims Reimbursement Clerk provides guidance to patients and providers regarding coverage limits, copayments, and other claim requirements. Liaises with insurance companies, providers, and patients to resolve discrepancies or obtain additional information. In addition, Claims Reimbursement Clerk maintains accurate records of claims, payments, and appeals in adherence to regulatory standards, requirements, and guidelines. May require an associate degree. Typically reports to a supervisor. Being a Claims Reimbursement Clerk works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. Working as a Claims Reimbursement Clerk typically requires 1-3 years of related experience.
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