Medical Claims Analyst at Fidelity Shield Insurance

The key deliverables for the role are;

• Review and assess medical claims for accuracy, completeness, and eligibility based on policy terms, medical guidelines, and coding systems
• Attending to providers, specialists and customer queries by determining their requirements, answering to these inquiries, resolving problems, and ensuring good service as a friendly cost.
• Adjudicating inpatient and outpatient medical claims while verifying the accuracy of information provided.
• Oversee quality control processes and claims assessment, adjudication, payment, and communication
• Monitor the quality of services provided by third-party vendors to ensure contractual obligations and service standards are met.

Qualifications;

• Bachelor's degree or a Diploma in Nursing, Clinical Medicine, Healthcare Management.
• Strong background in medical claims assessment will be a plus including knowledge of medical terminology, coding (ICD-10, CPT, HCPCS), and treatment procedures.
• At least 7 years’ of experience in health insurance claims adjudication, with at least 2 year out of those, in quality assurance.