Job Description
Review and process medical claims submitted by members or healthcare providers.
Check documents for completeness, including medical abstracts, itemized statements, and official receipts.
Verify member eligibility, benefits coverage, and policy limits.
Apply appropriate coding and benefits computation based on the member’s plan and HMO rules.
Bachelor’s degree in Business administration, Healthcare Management, Nursing, or a related field is preferred.
A diploma in medical, healthcare, or business-related field may be considered.
1-2 years of relevant experience in medical claims processing or administrative support in healthcare, hospitals, clinics, or insurance/HMO industries.
Familiarity with medical billing and reimbursement processes.
Experience working with HMO procedures and healthcare provider networks is a plus.
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