Insurance Claims Clerk
Help policy-holders appeal denied medical claims.
The medical world is built on tiny details. Minute fractions can sometimes spell the difference between life and death. As a Medical Claims Analyst, you don’t make such crucial life or death decisions, but you still play a powerful role in keeping the healthcare system up and running. You use your knowledge as a Medical Claims Analyst of medical treatments, accepted standards of care, and government or industry mandates to pick through medical claims and establish their validity.
The healthcare world is complex and complicated. When claims are submitted to a healthcare company or government agency, they can’t just be rubber-stamped through for payment. This would open up too much potential for waste and fraud.
Instead, the Medical Claims Analyst compares the information on each form with the allowable level of care for that diagnosis. You need to keep a slew of facts straight in your head, and develop an eye for overspending, improperly claimed credits, or fraudulent charges.
It’s painstaking, detail-oriented work, but you’re not alone. Even though you work independently, you’re part of a team of healthcare professionals. Computer skills, detail reading, and the ability to communicate well via email or in person are all crucial to your daily activities. A 40-hour workweek is the norm, but overtime may be required when deadlines approach.