skip to Main Content

Medical Claims Examiner Job Description

What does a Medical Claims Examiner do?

A Medical Claims Examiner is responsible for reviewing and processing health insurance claims submitted by healthcare providers on behalf of patients. They evaluate the claims to ensure that the medical services provided are covered under the patient’s insurance policy, determine the appropriate amount of payment, and identify any discrepancies or errors in billing. Medical Claims Examiners also communicate with healthcare providers and patients to resolve any issues or discrepancies and maintain accurate records of all claims processed. They must have a strong understanding of medical terminology, insurance policies and procedures, and legal regulations related to healthcare billing.

Our Medical Claims Examiner job description includes the Medical Claims Examiner responsibilities, duties, skills, education, qualifications, and experience.

Medical Claims Examiner Example

Our Job Advertising Packages

Choose the best package, edit the advert and post your job!

Indeed Sponsored
Google Jobs
LinkedIn Jobs
Guardian Jobs
Industry boards
CV Targeting*
many more
Job Advert Package + Flat Fee Recruitment Services
CV Filtering
Video Interviewing
Interview Scheduling

If you need an example job description for a Medical Claims Examiner download the one below, alternatively we have many other Banking and Insurance job description samples and a job description library with over 3000 job descriptions templates that you can download for free.

What does a Medical Claims Examiner do?

A Medical Claims Examiner is responsible for reviewing, processing and verifying medical claims submitted by healthcare providers. The Medical Claims Examiner is also responsible for ensuring that payments are accurate and processed in a timely manner. This position requires a keen eye for detail, excellent organizational skills and strong communication ability. The Medical Claims Examiner must be knowledgeable about health insurance policies, procedures and regulations to ensure that all claims comply with relevant laws. Other duties include researching denials and appeals, resolving disputes, keeping accurate records and maintaining customer satisfaction.

Medical Claims Examiner Role Purpose

The purpose of a Medical Claims Examiner is to accurately review, process and assess medical insurance claims in a timely manner. They must ensure that all claims comply with the insurance company's rules and regulations, as well as legal and ethical standards. They must also identify any discrepancies or errors in the claims and recommend appropriate corrective action. Medical Claims Examiners must maintain accurate records and ensure timely communication with claimants, insurers, and providers. They must also ensure that all insurance claims are settled in accordance with the terms of the policy.

Medical Claims Examiner Role

A Medical Claims Examiner is responsible for reviewing medical claims to ensure accuracy and compliance with insurance regulations. They are required to analyse medical records and other documents to determine the validity of the claims, make decisions on coverage, and calculate payments for services rendered. They must also keep accurate records of their findings and communicate with healthcare providers.

Medical Claims Examiner Duties

  • Review medical claims and accompanying documentation to determine coverage, benefits and eligibility
  • Verify accuracy of claim information
  • Calculate claims costs and amounts due
  • Make adjustments as necessary
  • Communicate with providers and insurers to resolve discrepancies
  • Update claims databases
  • Maintain records of claim processing
  • Perform quality control reviews

Medical Claims Examiner Requirements

  • A minimum of two years of experience in medical claims processing
  • Knowledge of medical terminology, insurance coding and billing procedures
  • Strong computer skills, including data entry and management, as well as a working knowledge of electronic medical record systems
  • Ability to work independently and meet deadlines
  • Excellent communication and organizational skills

Medical Claims Examiner Skills

  • Analytical and problem-solving ability
  • Excellent numeracy and communication skills
  • Attention to detail
  • Ability to work with confidential information

Medical Claims Examiner Personal Traits

  • Strong attention to detail
  • Excellent problem-solving skills
  • Highly organised
  • Ability to work well under pressure

How to write a Medical Claims Examiner Job Advert

Use our job advert template to write a job advert for posting on job sites and job boards. Our job advertising templates are carefully created to help you reach your audience and beat the competition to the best talent.

A job description informs the reader about a job, whereas a job advert’s main objective is to sell the job opportunity to attract as many suitable applicants possible. A job advert maybe the first touch-point a candidate has with your company so it is important to create a great impression.

Job Advertisements should enticing, so considering using short, exciting language which get the reader’s attention.

How to write a Medical Claims Examiner Job Description

To write a job description, we recommend starting with a job description template from our job description library, which contains examples for 800+ positions and professions. Our job description examples include a job summary with duties and responsibilities and skills and requirements, which can be personalised for your job vacancy.

Job Description Advice - Guidance on How to Personalise a Medical Claims Examiner Job Specification

The hiring process and recruiting new employees to fill your key roles requires a degree of personalisation if you are to attract the best employees in a competitive employment market. The right person for a crucial role or more senior roles will likely have other employers targeting them. As your job description will be the first point of contact, you need to nail your pitch and provide the best possible service.

Job Description Tips - Help on formatting a Medical Claims Examiner Job Specification

When creating your bespoke description and advert, you should cover and promote these points:

Job title: This should accurately reflect the role and include keywords that top talent might be using to search for jobs.

Job duties: The day to day duties, such as administrative tasks, which vary depending on the company and inform the candidate if they can complete the role.

Technical skills: These are the hard skills required through training, such as proficiency with Microsoft Office.

Soft skills: These include the interpersonal skills and general abilities the right candidates will possess. For example, the competency to prioritise multiple tasks, handle customer queries and customer complaints, work alone, or build a good relationship with coworkers.

The company's culture: Highlighting your company culture and values ensures employees thrive and find outstanding job satisfaction. Candidates that are not the right fit won’t waste their time completing the application process, meaning you can focus on qualified individuals and hire in a more timely manner.

Career progression: Including the career path will entice candidates looking for career growth. 

Training and development programs: Smaller companies may need employees with previous experience or provide educational assistance over internal training offered by larger organisations with more significant resources. 

Employee benefits: Compensation and benefits often fail to appear in job ads and while you may want to hold your cards close to your chest, failing to include them is a mistake. Consider answering common questions, such as working hours and paid leave. Researching the average salary for the role in these early stages will ensure you don’t waste your interviewer’s and the candidate’s time.

Skill gaps: Your company may need to bring in new skills beyond those required to complete the key role and duties. Thinking on an organisational level can be beneficial when contemplating skills diversity.

Legal requirements: Ensure your job advert and description does not ask for inappropriate or discriminatory personal details, such as age, marital status, or religion.

How to Hire a Medical Claims Examiner

Once you have selected your Job Description download it or convert it to a Job Advert. From here you can post/advertise your job across our network of job boards. If you wish to use the job description for a CV Template click through for advice and Convert to a CV

Back To Top