Claim analysts work in hospitals, insurance companies or government offices. Their main job is to see whether the claims that have been submitted are valid or not. They have to decide whether the insurance company will make the bill payments or not. They are required to have knowledge about medical terminologies.
Some of the important works that they tend to do are as follows:
- They have to review the claims made by the client.
- They have to validate the claim.
- It is there sole discretion whether a claim will be accepted without any denials, or they will get delay.
- He has to review all the pending cases as fast as they can do it.
- They may be required to contact the employer of the client if need arises.
- They should use the claim workflow to keep him updated about the pending cases.
- He has to perform any claim related duty, as and when, required to do so.
The important duties related to this job are as described below:
- They have to check whether the bills are true or not, and they also have to see that they are complete in all aspects.
- They have to check the importance of the treatment that the client has undergone the effectiveness of the treatment and to see that the hospitalization was necessary or not.
- He may demand further investigation, if he is not satisfied with the bills and find them unreasonable.
- Before making the final payment, they may want to make some final investigations.
- They also review the payments made to the parties and check whether they are in order or not.
- If he finds some mistakes in the bill payments, then he tries to claim it.
The important skills required for this job are as described below:
- They should possess good analytical and organizational skills.
- They must have good computer skills.
- They must have knowledge about medical terminologies.
- They should be aware of the laws regarding medical billing.
- They should have very good statistical analysis skills.
- He should be able to follow the proper billing standards.
- They should have very good communication skills.
- He should be able to write proper reports.
- He should be able to understand the insurance policy terms and conditions.
The working conditions can be described as follows:
- They have to work from either the insurance company office or from the medical organization, which he is working for.
- They have fixed work hours, and they have holidays on Sundays and other public holidays.
- They may be required to travel for work.
- Their job does not have any physical stress.
- They have to work under pressure and meet the deadlines.
The important qualifications required for this job are as described below:
- They should be a graduate in mathematics or commerce.
- A certificate in computers is an added advantage.
- They should have a diploma in insurance claims policies.
- Having an experience of few years is an added advantage.
Tips for Jobs
The candidates who want to take this profession should keep the following tips in mind:
- They should be highly analytical.
- They must have good knowledge about the rules regarding the claim policies.