331503 - Medical Insurance Technician Decide on the size and validity of medical insurance claims, investigate any potential fraudulent activities based on inspection reports, ensure claims are processed through ratification or rejection, and determine compensation
Main Tasks:
Assess the validity of medical insurance claims, determine insurance policy coverage, review inspectors' reports on the validity of claims, and document the reasons for accepting or rejecting the claim
Determine the type and size of compensation for certified medical insurance claims, and assess compensation levels based on insurance policy coverage and conditions
Process medical insurance claims and ensure the payment of compensation, or the notification of claim rejection
Explain the process of medical insurance claim validation, answer questions, and review objections and appeals.
Apply OHS procedures and instructions.
Educational Level:
Educational Field:
Finance, banking and insurance
Skills:
Technical skills:
