- Attending to providers, specialists and customer queries by determining their requirements, answering to these inquiries, resolving problems, and ensuring good service as a friendly cost.
- Adjudicating inpatient and outpatient medical claims while verifying the accuracy of information provided.
- Managing healthcare costs by ensuring that care is appropriate, cost-effective, and aligned with policy coverage.
- Bachelor's degree or a Diploma in Nursing, Clinical Medicine, Healthcare Management.
- Strong background in medical claims assessment will be a plus including knowledge of medical terminology, coding (ICD-10, CPT, HCPCS), and treatment procedures.
- At least 1 to 3 yearsâ of experience in health insurance claims processing, adjudication, or claims management.
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