What are the responsibilities and job description for the Claims Examiner position at Harris Computer?
Responsibilities & Duties:Claims Processing and Assessment:
- Evaluate incoming claims to determine eligibility, coverage, and validity.
- Conduct thorough investigations, including reviewing medical records and other relevant documentation.
- Analyze policy provisions and contractual agreements to assess claim validity.
- Utilize claims management systems to document findings and process claims efficiently.
- Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements.
- Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process.
- Address customer concerns and escalate complex issues to senior claims personnel or management as needed.
- Ensure compliance with company policies, procedures, and regulatory requirements.
- Maintain accurate records and documentation related to claims activities.
- Follow established guidelines for claims adjudication and payment authorization.
- Identify opportunities for process improvement and efficiency within the claims department.
- Participate in quality assurance initiatives to uphold service standards and improve claim handling practices.
- Collaborate with team members and management to implement best practices and enhance overall departmental performance.
- Generate reports and provide data analysis on claims trends, processing times, and outcomes.
- Contribute to the development of management reports and presentations regarding claims operations.