Nursing Examinees
Job description medical claims examiner
A medical examiner claims (sometimes called a claims examiner of health insurance or a claims examiner) processes requests for payment related to medical treatment and determines to pay compensation or not. Many claims examiners work for insurance companies, but some claims examiners work for government, particularly in the state agencies responsible for workers' compensation and federal agencies, such as insurance Medicare.
Examination of the representation
A medical examiner claims assess each application for completeness and accuracy. If essential, the examiner might go again the request for Interview, information medical specialists, or right to see report data to verify the policy files. The examiner also determines whether costs are sensible specified the diagnosis, based on information available about treatments expected average remaining hospital for an assortment of ailments and, where appropriate, the average duration of disability. The examiner then authorize payment, deny the assert or the claim refers to an investigator for further review.
Other functions and powers
A medical examiner claims must maintain present files with all the proper forms, reports, maintain records and statements and organize reports and correspondence related to work. Other duties may include responding to inquiries and complaints related to claims of providers, attorneys, employers and agents and dealing ahead, rehabilitation and mediation hearings payment.
Examiner requests must be neat, accurate and complete, must be familiar with the terminology and processes medical insurance and to have integrity and good judgment.
Education
According to the Handbook of career opportunities, become a medical examiner claims has no requirement of formal education, however, the majority employers choose to take into service college graduates or people who have jobs related to insurance to experience or training. For example, the Michigan Civil Service Commission requires a bachelor's degree with a major in business administration, insurance or a field related to health (such as nursing, physician assistant or pharmacist).
Advancement
An entry level examiner may provide only the basic functions of review. As reviewers gain experience, they can take on additional responsibilities, including roles as a supervisor or manager. The International Association of the claim offers an educational program to help claims examiners advanced in their field.
Salary
According Indeed, the average annual salary for a medical claims examiner is $ 41 000.
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