Description
Reviewing, analyzing, and processing insurance claims to determine their validity and ensure compliance with policy terms. This role involves verifying documentation, liaising with various stakeholders, and recommending claim settlements or repudiation. The position requires strong analytical skills, attention to detail, and a solid understanding of insurance policies and procedures.
1. KEY TASKS AND RESPONSIBILITIES
Review and evaluate insurance claims for accuracy, completeness, and compliance with policy guidelines.Investigate claim details, including gathering supporting documentation and consulting with claimants, service providers, or third parties as needed.Determine the validity of claims and make recommendations for payment, denial, or further investigation.Calculate appropriate benefit amounts or reimbursements in accordance with policy terms and coverage.Communicate with policyholders or oth...