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Alternate job titles: Insurance Claims Documentation Analyst | Insurance Claims Validation Analyst

Analyzes and reviews insurance claims for accuracy, completeness, and eligibility. Reviews claims for eligibility to be reimbursed. Maintains updated records and prepares required documentation. Assists in controlling the cost of processing claims. Contacts policyholders about claims and may provide information regarding the amount of benefits. May require a bachelor's degree or its equivalent. Typically reports to a supervisor or manager. Gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. Typically requires 2 to 4 years o more...



Alternate job titles: Claims Analyst | Insurance Claims Validation Analyst

The Insurance Claims Documentation Analyst reviews claims for eligibility to be reimbursed. Analyzes and reviews insurance claims for accuracy, completeness, and eligibility. Being an Insurance Claims Documentation Analyst assists in controlling the cost of processing claims. Maintains updated records and prepares required documentation. In addition, Insurance Claims Documentation Analyst contacts policyholders about claims and may provide information regarding the amount of benefits. May require a bachelor's degree or its equivalent. Typically reports to a supervisor or manager. Being an Insu more...


Alternate job titles: Claims Analyst | Insurance Claims Documentation Analyst

The Insurance Claims Validation Analyst reviews claims for eligibility to be reimbursed. Analyzes and reviews insurance claims for accuracy, completeness, and eligibility. Being an Insurance Claims Validation Analyst assists in controlling the cost of processing claims. Maintains updated records and prepares required documentation. In addition, Insurance Claims Validation Analyst contacts policyholders about claims and may provide information regarding the amount of benefits. May require a bachelor's degree or its equivalent. Typically reports to a supervisor or manager. Being an Insurance Cla more...


Alternate job titles: Medical Policy Specialist

The Provider Claims Process and Controls Analyst recommends a policy and process that ensure alignment with company guidelines and nationally accepted medical/coding standards. Researches and designs criteria to determine policy guidelines used in review of patient cases to ensure only medically appropriate services are reimbursed. Being a Provider Claims Process and Controls Analyst responds to questions from medical staff and communicates details about policy and guidelines. Establishes the proper codes to use for claims processing. In addition, Provider Claims Process and Controls Analyst r more...



Alternate job titles: Claims Payment Processing Clerk

Reviews insurance claims forms and documents for accuracy and completion and obtains missing information as necessary. Determines claims coverage by examining company records. Responsible for calculating claims amounts and submitting claims for payment. Requires a high school diploma or its equivalent. Typically reports to a supervisor. Possesses a moderate understanding of general aspects of the job. Works under the close direction of senior personnel in the functional area. May require 0-1 year of general work experience. more...


Alternate job titles: Claims Service and Operations Director

Directs and oversees the operations of an insurance claims department to meet operation, financial, and service requirements. Provides guidance and sets policies on insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Responsible for the strategic processing and payment of claims. Keeps abreast of any changes to legislation and regulations which pertain to insurance claims. Provides guidance to subordinates on the most complex claims. Requires a bachelor's degree. Typically reports to top management. Manages a departmental sub-function more...



Alternate job titles: Claim Review and Settlement Examiner | Claims Investigator | Insurance Claims Examiner

Reviews, evaluates and processes insurance claims and makes recommendations for resolution. Examines, and authorizes insurance claims investigated by insurance adjusters. Studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Has contact with agents, claimants, and policy holders. Determines settlement according to organization practices and procedures. Typically requires a bachelor's degree. Typically reports to a supervisor or manager. Works on projects/matters of limited complexity in a support role. Work is closely more...


Alternate job titles: Claim Examinations/Adjustments Manager | Claims Settlement Manager

Responsible for managing the insurance claims department composed of Examiners and Adjusters. Operates of one or more claims processing units, including the timely and proper disposition of claims in accordance with coverage amounts. Oversees insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Ensures complete and sound claim settlements, legal reviews and investigations in accordance with company policies and procedures. Requires a bachelor's degree. Typically reports to top management. Typically manages through subordinate managers a more...


Alternate job titles: Claim Review and Settlement Examiner | Insurance Claims Examiner

The Claims Investigator examines, and authorizes insurance claims investigated by insurance adjusters. Reviews, evaluates and processes insurance claims and makes recommendations for resolution. Being a Claims Investigator has contact with agents, claimants, and policy holders. Studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. In addition, Claims Investigator determines settlement according to organization practices and procedures. Typically requires a bachelor's degree. Typically reports to a supervisor or manager more...



Alternate job titles: Claims Tracking and Reporting Clerk

Responsible for inputting new claims, processing payments, conducting billing research and responding to telephone inquires. Determines whether to return, deny, or pay claims according to organizational policies and procedures. Reviews and dispositions claims. Prepares daily reports for claims management team. Requires a high school diploma or its equivalent. Typically reports to a supervisor. Possesses a moderate understanding of general aspects of the job. Works under the close direction of senior personnel in the functional area. May require 0-1 year of general work experience. more...


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