Job Role Description

Medical > Medical Claims Assistant

Salary National Average

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37640.0000 44630.0000 54370.0000

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Short Description:

A Medical Claims Assistant supports the processing of healthcare-related claims by handling administrative duties and assisting claims examiners and adjusters. Their responsibilities include reviewing medical claim forms for accuracy, entering patient and treatment information into claims systems, and coordinating with healthcare providers or patients to obtain necessary documentation. Medical Claims Assistants also track claim statuses, verify insurance coverage, and ensure compliance with healthcare regulations and billing procedures. Strong attention to detail, organizational skills, and knowledge of medical terminology are essential for success in this role, as Medical Claims Assistants play a key role in ensuring the efficient and accurate handling of medical claims.

Duties / Responsibilities:

  • Research to find all policies held by the insured
  • Assist Claims Rep in verifying facts and coverage, and document files
  • Advise customers what processes are necessary for claims settlement
  • Enters new losses into the claim system
  • Research new losses
  • Assigns new losses
  • Assists with phone coverage at the front desk
  • Manages, organizes, and routes incoming/outgoing mail
  • Answering phones and directing calls
  • Filing and organizing closed claim files.

Skills / Requirements / Qualifications

  • Active Listening: Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
  • Reading Comprehension: Understanding written sentences and paragraphs in work related documents.
  • Speaking: Talking to others to convey information effectively.
  • Critical Thinking: Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
  • Monitoring: Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.
  • Time Management: Managing one's own time and the time of others.
  • Education: High school diploma or general education degree (GED) required
  • Experience: 1-2 years of experience in a customer service or administrative role (preferably in the insurance industry)
  • Licensure: 6-20 adjuster's license or customer service license preferred or willing to become licensed within one year of hire
  • Skills: Able to multitask and be organized in a high-volume environment. Detail-oriented and highly organized. Masters new job tasks swiftly.
  • Abilities: Ability to work in and learn multiple software systems. Excellent verbal and written communication skills and professional demeanor
  • Software: Good knowledge of Microsoft Office, including Word, Excel, and Outlook

Job Zones

  • Title: Job Zone Two: Some Preparation Needed
  • Education: These occupations usually require a high school diploma.
  • Related Experience: Some previous work-related skill, knowledge, or experience is usually needed. For example, a teller would benefit from experience working directly with the public.
  • Job Training: Employees in these occupations need anywhere from a few months to one year of working with experienced employees. A recognized apprenticeship program may be associated with these occupations.
  • Job Zone Examples: These occupations often involve using your knowledge and skills to help others. Examples include sheet metal workers, forest fire fighters, customer service representatives, physical therapist aides, salespersons (retail), and tellers.
  • Specific Vocational Preparation in years: (4.0 to < 6.0)

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