While you take care of your patients’ physical health, it’s your medical claims specialist/examiner who takes care of their financial health. To help you find a well-qualified candidate, you have to put an abundance of thought and time into your job description. If not, you risk wasting several hours sorting through the application materials of unqualified individuals who may have been mislead by your poorly formatted job description. To save you time and frustration, it’s a good idea to check out a medical claims specialist/examiner job description sample.
Medical Claims Specialist/Examiner Job Summary
As the medical claims specialist/examiner of the Silverthorne County Medical Mall, you’ll determine whether patients have insurance coverage and help them with their medical claims. You’ll also make sure all actions taken are thoroughly documented and that you adhere to our policy of delivering quality customer service to each of our patients and their families. You must also ensure 100 percent legal and industry compliance throughout the entire claims process.
Medical Claims Specialist/Examiner Job Responsibilities & Duties
- Examine claims records and forms to determine whether the patient has medical insurance.
- Review provisions of certificate or policy to determine the patient’s included medical coverage losses.
- Negotiate claim settlements and make recommendations for legal action when settlements are deemed non-negotiable.
- Complete logs, reports, forms and records to properly document medical claims.
- Reject or accept documentation, determine benefit due, and start the denial or payment process to resolve medical claims.
- Adhere to all company policies, procedures and guidelines in addition to insurance regulations at the federal and state level.
- Examine medical treatment records, police reports, physical property damage and medical bills to gauge overall extent of liability.
- Interview and communicate with claimants, police, witnesses, physicians and other necessary individuals to decide claim denial, settlement or review.
- Ensure all claims information remains confidential.
- Engage in continuing education and training opportunities when possible.
Medical Claims Specialist/Examiner Skills & Qualifications
- At least a bachelor’s degree
- At least three years of experience working in the medical field
- At least two years of experience as a medical claims specialist/examiner
- Detail oriented
- Interpersonal skills
- Analytical abilities
- Data entry skills
- Knowledge of FDA health regulations
Started in 2000, the Silverthorne County Medical Mall was designed to take care of a wide variety of patient needs all in one central location. Our aim is to provide the absolute best medical services in an efficient yet thorough manner designed to meet all patient health needs. We use cutting edge technology throughout our Silverthorne facilities to treat patients, retain medical information, diagnose patients and handle medical payments. Our medical services are also designed in a way that’s affordable to those with and those without insurance. We don’t believe patients should have to go bankrupt in order to take proper care of their health.
What to Include in Your Medical Claims Specialist/Examiner Job Description
Ultimately, it’s you who decides what to include on your medical claims specialist/examiner job description. To keep your description from being longer than necessary, think of the qualities and qualifications that are the most important to you and your practice. Additionally, consider the type of information in which potential applicants are likely to be the most interested. Examples of some of the most common sections to include in a job description include:
Job Title & Summary – Think about the type of medical claims specialist you need. Maybe you already have a specialist who needs a bit of assistance, or perhaps you only need a part-time claims specialist. In any case, make sure you keep the title of the position as clear as possible and that you support that title with a summary of the most important responsibilities of the job. It’s best to keep this section to just one to three short and sweet sentences.
Responsibilities – After checking out the job title and summary, readers will either feel they aren’t qualified for the title and look elsewhere or keep reading to find out more. Those who keep reading or feel on the fence about their qualifications should be able to solidify their decisions after reading the responsibilities section of the job description. Go into more detail about the responsibilities touched on in the summary. Your main goal here is to give potential applicants an idea of the tasks they’ll be performing on a day-to-day basis. Offer five to 10 responsibilities, each of which should be started with an action verb.
Company Information – While a candidate might be the perfect fit for your medical claims specialist/examiner job description, that individual might not exemplify your company culture. Be sure you include a description about your practice or business and the type of work environment in which applicants can expect to work. Here is where you’ll want to be as honest and transparent as possible.
SEO – Throwing in a few keywords throughout your job description is a good way to capture the interest of applicants who might be using those same keywords to find medical claims specialist/examiner jobs through search engines. With that in mind, you want to be careful that you don’t go overboard with your SEO, keyword and keyphrase strategy. Too many keywords in your description looks unprofessional and often makes your copy unbearable to read. Choose your keywords and your keyword placement carefully to yield the true benefits of this strategy.
Call to Action – Be sure you let interested candidates know how you expect them to respond to your medical claims specialist/examiner job description. Are you looking for resumes, or would you rather a candidate set up an interview?
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Writing Your Medical Claims Specialist/Examiner Job Description: Best Practices
Be sure to adhere to these dos and don’ts to improve your chances of finding the perfect medical claims specialist/examiner:
DO make use of bullet points when the opportunity presents itself. Doing so gives your job description a cleaner look.
DO include contact information on your job description for anyone who might have questions.
DON’T include anything in the job description regarding salary or benefits if doing so goes against your most current company policy.
DON’T forget to keep your sentences as short and concise as possible. Remember that there will be plenty of time to go over more details during the interview. The job description is just to pique interest and attract the best candidates.
DO remember to be as transparent and honest as possible throughout your description. Doing so goes a long way in making sure you start off your relationship with your new medical claims specialist/examiner on the right foot.
Best Practices for Writing a Job Description
If you feel that the above medical claims specialist/examiner job description sample simply doesn’t apply to your unique situation, don’t despair. There are a few best practices for you to bear in mind while crafting your job description to ensure you stand the best chance of attracting the type of candidate who is the perfect match for your company or practice.
DO remember to use specific language throughout your job description. This helps paint a clear picture of how applicants can expect to spend their time on a daily basis. Direct language also helps eliminate unqualified candidates.
DON’T forget to add a few points about your company culture throughout the job description. While a potential applicant may be well qualified for the position, he or she may not have the right personality that complements your current workforce.
DO include the geographic location of your practice or business in order that candidates know how far they’ll have to travel to and from work. What’s more is that you should also mention whether you’re open to hiring out-of-state applicants and if you’ll compensate them for their moving expenses.
DON’T add anything about salary or benefits if doing so would risk breaking company policy. You don’t want to jeopardize your position while attempting to fill another.
DO be sure to include contact information and a call to action at the bottom of your job description. Let applicants know the type of submission materials you desire and how long they have to apply.