A claims/billing processor works for an insurance company to process claims from clients and analyze patient files to make sure patients are eligible for said claims. He/she may determine a claim's eligibility independently or pass it on to investigators or another department for review, and will also determine how much is owed by the customer, if anything, and bill accordingly.
Claims processors may work directly with customers to gather their claims. This usually involves communicating on the phone, so good telephone skills are important. The claims processor will look over claims and make sure they're complete; when they're not, the necessary information should be obtained to complete the claims. He/she may also have to follow up with the claim to make sure the process is carried out in a timely manner, and help with processing new client registrations.
Usually, a minimum of a high school diploma is required. Proficient ten key and typing skills are necessary in order to carry out this job efficiently. When working with medical insurance, knowledge of medical terminology and coding will be necessary. The job is generally carried out in an office environment, which may require the processor to sit at a desk and computer for long shifts. The office may also get noisy, as multiple claims processors may work in one area.
Claims Processor/Billing Tasks
Update database and process necessary paperwork.
Reviews claims for accuracy and completeness, verify eligibility and coverage level.
Assists in making claim settlement determinations.
Provides customer service to clients.