Insurance/Claims Representative

Job Overview

The Insurance/Claims Representative is responsible for reviewing, processing, and managing insurance claims while delivering outstanding client support. This role involves interacting with patients, providers, and insurance carriers to resolve issues, verify coverage, and ensure claims are handled accurately and efficiently. The ideal candidate has a solid background in healthcare or insurance, excellent organizational skills, and a strong grasp of claims procedures and medical terminology.

Responsibilities

• Process Claims: Review and handle incoming claims from healthcare providers and patients for accuracy and policy compliance.
• Support Clients: Respond to client inquiries about claims, policy coverage, and claim statuses in a timely and helpful manner.
• Verify Eligibility: Confirm patient insurance coverage and service eligibility; update records as needed.
• Manage Documentation: Keep detailed and organized records of claims, correspondence, and client interactions; generate reports when needed.
• Resolve Issues: Investigate and resolve claim discrepancies, payment issues, and eligibility concerns with insurers or providers.
• Stay Compliant: Stay up to date with healthcare regulations and insurance industry standards to ensure compliance.
• Work as a Team: Coordinate with internal departments (billing, underwriting, legal) to address client concerns and enhance operational efficiency.

Job Qualifications and Skill Sets

• Prior experience in healthcare insurance, claims processing, or a similar role is strongly preferred.
• Solid understanding of health insurance policies, claims workflows, and medical terminology.
• Proficient in Microsoft Office Suite and claims management software (specific platform experience is a plus).
• Strong communication and interpersonal abilities for interacting with clients, providers, and internal teams.
• Highly organized and detail-oriented, with strong analytical and problem-solving skills.
• Ability to prioritize tasks independently and work effectively in a fast-paced environment.