Insurance Claims Specialist

Analyze routine insurance claims to determine the extent of the insurance carrier's liability and to settle claims in accordance with the plan provisions The Claims Specialist sets adequate reserves to ensure proper reporting. Compares data on claim form with insurance plan to ascertain completeness and validity of claim. Examines claim form and other records to determine insurance coverage. Proactively works to resolve claim as expeditiously as possible. Reviews and analyze detailed medical records. Calculates reimbursement of benefits according to the schedule of coverage. Runs various claim reports as directed by the account. Approves claims at the appropriately demonstrated assigned authority