Answer :
Employed by third-party payers, a claims examiner reviews health-related claims to ascertain if the charges are reasonable and medically required in light of the patient's condition.
What duties does a claim examiner have?
- Examining Claim Findings and Payment Procedures
- Carrying out administrative tasks
- Asking Questions of Others
Skills of claim examiners:
- Claim examiners need to have a strong understanding of the written word.
- The fact that claims examiners provide written reports on their findings necessitates the need for strong writing abilities.
- Examiners have the logic and reasoning needed to assess and settle claims thanks to critical thinking and decision-making.
- Negotiation skills are crucial, especially when two parties disagree on a filing's legality or the details required to resolve a claim.
- Understanding medical terminology and having paralegal or investigative skills are also crucial.
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