Insurance Claims Specialist
On-siteMandeville, Manchester, Jamaica
Job Summary
Review and process incoming medical claims in accordance with company policies, guidelines, and regulatory requirements. Accurately enter claimants' insurance data into claims processing systems and analyze supporting documents to determine accuracy and eligibility. Identify discrepancies, follow up with providers or claimants, and apply medical knowledge to interpret clinical notes and diagnostic codes. Document all actions clearly, collaborate with Quality Assurance and Medical Review units to resolve complex cases, and escalate high-risk claims as needed. Ensure timely adjudication while maintaining productivity and quality standards. Respond to internal queries regarding claim statuses and support continuous improvement through trend identification.
Required Qualifications
- High school diploma or equivalent
- Associate degree or certification in medical billing
- 1+ years of claims processing experience in medical claims entry, billing or a related health care administrative role
- Familiarity with medical terminology
- Comfort reviewing medical records or clinical documentation
- Familiarity with U.S healthcare system
- Familiarity with insurance terminology
- Familiarity with claims processing
- Strong analytical and critical-thinking skills
- High attention to detail
- Excellent written and verbal communication skills
- Ability to work independently
- Proficiency in claim systems
- Proficiency in Microsoft Office
- Proficiency in general computer software
- Strong organizational and time management skills
Desired Qualifications
- Associate degree or certification in medical billing a plus
- Minimum of 1+ years of claims processing experience in medical claims entry, billing or a related health care administrative role preferred
- Familiarity with medical terminology and comfort reviewing medical records or clinical documentation
- Familiarity with U.S healthcare system, insurance terminology and claims processing
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