Medical Claims Processor Job Description


General Job Description:

Healthcare claims processors function in hospitals, clinics and doctors’ office buildings where their prime responsibility should be to handle insurance statements from patients. They check out claim coverage and also validity. They are likely to review and evaluate claims submitted by patients to ensure they were indeed covered for the medical procedure by the said insurance organization.

Medical claims processors function closely with insurance companies this is why they need to generate and maintain close relations with them. When calling straight into ask the status of any claim, medical claims processors will often be made to wait for an extended time before they are supplied with the information they require. A seasoned statements processor will discover how to get about holding on the phone all night; experienced claims processors develop a contact within each insurance firm and ask to speak to their contact each and every time they call in which saves them considerable time.

Once a claim has been verified as accurate, it is the job of a medical claims processor to be able to remit the check. In case of any denial, he are going to be expected to write on the insurance company, the person and the doctor to produce information of denial. In many situations, a denied state is resubmitted by the claims processor that puts in additional information which may be needed to produce the claim valid.


There is no basic education required for this position however, many training in medical claims and codes is provided once a person is hired. A medical statements processor will guarantee that reviews each state in his declare accuracy and completeness. In the event of missing information, he could be expected to call the person and clarify the confusion.

While some establishments provide medical statements processors with at work training, most require which the person applying for this job possesses some understanding of medical terminology. It is because medical claims processors are necessary to read medical documents in order to decipher information that they may need for addressing the insurance firms or the affected individuals.

Job Duties for Medical Claims Processor Resume

• Authenticated the details on all medical claims received

• Reviewed and also made sure there is no omitted details

• Answered inquiries from providers on the subject of claim, eligibility, coated benefits and approval status issues

• Kept in depth records of statements and followed through to dropped cases

• Entered statements into computer utilizing understanding of CPT, ICD-9 codes and medical terminology

• Read and also assessed medical papers.

• Managed and also processed insurance statements


• Documented many activities through CRM.