Provide correct billing codes for medical procedures so payments are fair.
As an Insurance Claims Clerk, you play a key role in the system of checks and balances that catch insurance companies’ mistakes and settle disputes over denied claims. It’s your job to interview clients and collect their paperwork to start the settlement process.
Typically as an Insurance Claims Clerk you would deal with whom have had their claims denied, or are unsure how to file claims in the first place. Your understanding of the insurance companies’ policies and the legal requirements for filling out claims makes you, the Insurance Claims Clerk, just the right person to help them out.
First, you collect your client’s information for processing. Once you have their side of the story, it’s time to review their insurance policy. Medical and auto claims are most common, and each person has a policy detailing when and how much the insurance will pay.
If the person’s claim meets the required conditions, you finish the necessary paperwork and send it on for processing. In cases where a claim is being disputed and the insurance still refuses to pay, you send the case elsewhere for investigation.
You act as a mediator between the two parties—the insurance company and the person filing—to negotiate an agreement. Most cases go through quickly, though some require a full examination. It’s up to you to catch and solve errors, and decide which cases deserve a thorough review to ensure that each person is provided the insurance coverage they’ve paid for.