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Medical Claims Specialist Job Description

What does a Medical Claims Specialist do?

A Medical Claims Specialist is primarily responsible for processing medical insurance claims from patients or healthcare providers. They must ensure that all claims are accurate, complete, and comply with legal and regulatory requirements. This involves verifying patients’ insurance coverage, determining the amount of reimbursement for healthcare services, and submitting claims to insurers or government agencies for payment. They may also communicate with insurance providers or healthcare professionals to resolve claim discrepancies or denials. Additionally, Medical Claims Specialists may maintain patient records and handle other administrative tasks related to medical billing and insurance claims processing.

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

Medical Claims Specialist Example

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If you need an example job description for a Medical Claims Specialist 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 Specialist do?

A Medical Claims Specialist is responsible for processing medical claims for their organisation. They will review medical records and ensure accuracy of the claim information, verify coverage and eligibility, and input data into the organisation's systems. The specialist will also provide guidance to customers on the claims process, and will liaise with insurance companies to ensure prompt reimbursement. This role requires strong organisational, administrative and communication skills, as well as a comprehensive understanding of medical terminology and medical coding.

Medical Claims Specialist Role Purpose

The purpose of a Medical Claims Specialist is to process medical claims and ensure that they are accurate, complete, and compliant with relevant regulations. They are responsible for verifying coverage, confirming eligibility, and assessing the validity of medical claims. They review and process medical claims submitted by healthcare providers and ensure that they are paid in a timely manner. They also provide guidance and assistance to healthcare providers in resolving any claims-related issues. Additionally, they provide support to insurance companies and adjusters in processing and resolving claims.

Medical Claims Specialist Role

A Medical Claims Specialist is responsible for processing medical insurance claims for patients, ensuring accuracy of data and timely submission of claims to insurance providers. They must have a good understanding of insurance policies and procedures, as well as excellent communication and problem-solving skills.

Medical Claims Specialist Duties

  • Processing and verifying medical claims
  • Analyzing medical bills for accuracy and completeness
  • Researching and resolving medical claims issues
  • Tracking medical claims status
  • Communicating with medical offices, patients and insurance companies

Medical Claims Specialist Requirements

  • Ability to accurately process medical claims
  • Knowledge of medical terminology
  • Proficiency in medical coding
  • Knowledge of medical billing processes and procedures
  • Experience working with medical insurance providers

Medical Claims Specialist Skills

  • Proficient in administrative and organizational tasks
  • Extensive knowledge of medical billing and coding procedures
  • Excellent communication skills
  • Ability to manage multiple tasks at once
  • Strong problem-solving and analytical skills

Medical Claims Specialist Personal Traits

  • Strong organizational skills
  • Attention to detail
  • Analytical thinking
  • Excellent communication and interpersonal skills

How to write a Medical Claims Specialist 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 Specialist 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 Specialist 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 Specialist 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 Specialist

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