Medical Claims Examiner

Job Title: Claims Adjudicator (Medical Claims/Medical Malpractice)

Key Responsibilities:

1. Claims Adjudication: Review and process medical claims, ensuring accuracy and compliance with regulations and policies.

2. Medical Malpractice: Handle claims related to medical malpractice, assessing liability and determining appropriate actions.

3. Decision-Making: Make informed decisions on claims, taking into account medical records, policy terms, and relevant laws and regulations.

Requirements:

1. Experience: 6+ years of experience in claims adjudication, preferably in the medical or insurance industry.

2. Medical Knowledge: Strong understanding of medical terminology, procedures, and practices.

3. Analytical Skills: Excellent analytical and problem-solving skills, with the ability to interpret complex medical information.

4. Communication Skills: Strong communication and interpersonal skills, with the ability to work with healthcare providers, policyholders, and other stakeholders.

Industry:

1. Insurance: Experience in the insurance industry, particularly in claims adjudication, is highly valued.

2. Medical: Knowledge of medical practices, procedures, and terminology is essential for this role.