Claims Officer
Other Accounting Jobs Information
* Examine submitted claims for completeness, accuracy, and compliance with insurance policy terms
* Identify and address any discrepancies or inconsistencies in claim information
* Respond to inquiries from policyholders, healthcare providers, and internal departments regarding claims
* Implement measures to prevent and detect fraudulent activities
* Ensure compliance with all applicable laws, regulations, and company policies related to claims processing
* Determine coverage based on policy provisions and medical necessity
* Identify and address any discrepancies or inconsistencies in claim information
* Coordinate with medical professionals or external reviewers to obtain additional information or clarification
* Identify and investigate potential fraudulent claims
* Liaise with other departments within the insurance company, such as underwriting or customer service, as needed