Medical Claims Processor / Representative
Quick Facts
Median Salary$45,209
Most Common EducationHigh school or GED
Projected 10-Year Growth-3.96%
Assessment MatchTake the Assessment
What They Do
A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
Core Tasks:
- Prepare insurance claim forms or related documents, and review them for completeness.
- Calculate amount of claim.
- Post or attach information to claim file.
- Transmit claims for payment or further investigation.
- Contact insured or other involved persons to obtain missing information.
- Review insurance policy to determine coverage.
- Process and record new insurance policies and claims.
- Organize or work with detailed office or warehouse records, using computers to enter, access, search or retrieve data.
- Provide customer service, such as limited instructions on proceeding with claims or referrals to auto repair facilities or local contractors.
- Correspond with insured or agent to obtain information or to inform them of account status or changes.
- Review and verify data, such as age, name, address, and principal sum and value of property, on insurance applications and policies.
- Compare information from application to criteria for policy reinstatement, and approve reinstatement when criteria are met.
- Examine letters from policyholders or agents, original insurance applications, and other company documents to determine if changes are needed and effects of changes.
- Transcribe data to worksheets, and enter data into computer for use in preparing documents and adjusting accounts.
- Notify insurance agent and accounting department of policy cancellation.
What to expect as a Medical Claims Processor / Representative
1Earn a High school or GED Diploma
56% of people achieve this level of education.
2Gain skills and experience
See Medical Claims Processor / Representative related courses on Tallo
3Land a job
519 openings for Medical Claims Processors / Representatives
Career Progression
in United States (Nation)
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