Medical Claim Analyst

We're currently assisting one of our clients, a leading insurance broker company committed to providing exceptional service and comprehensive insurance solutions to their clients. They specialize in a wide range of insurance products and services, ensuring our clients receive the best possible coverage and support. Job Summary: As a Claim Analyst with a medical background, you will play a crucial role in evaluating, analyzing, and processing insurance claims. Your expertise in the medical field will be essential in assessing the validity of claims, determining coverage, and ensuring accurate and fair claim settlements. You will collaborate with clients, healthcare providers, and insurance adjusters to ensure the efficient and effective handling of claims. Key Responsibilities: - Review and analyze medical insurance claims to ensure accuracy and compliance with policy terms and conditions. - Evaluate medical records, treatment plans, and other relevant documents to assess the validity of claims. - Determine the extent of insurance coverage and appropriate claim settlements based on medical evidence. - Communicate with healthcare providers, clients, and insurance adjusters to gather necessary information and clarify details. - Provide expert medical opinions and recommendations on complex claims. - Identify and investigate potential fraudulent claims and take appropriate action. - Maintain accurate and detailed records of all claim activities and correspondence. - Collaborate with the legal team, if necessary, to support claim resolution. - Stay up-to-date with industry regulations, medical advancements, and insurance policies. - Participate in training and development programs to enhance knowledge and skills. Qualifications: - Medical degree (MD or equivalent) from an accredited institution. - Valid medical license and board certification in a relevant specialty. - Minimum of 3 - 5 years of clinical experience in a healthcare setting. - Previous experience in insurance claims analysis or a related field is preferred. - Strong knowledge of medical terminology, procedures, and treatment protocols. - Excellent analytical and critical thinking skills. - Attention to detail and accuracy in reviewing and assessing claims. - Strong written and verbal communication skills. - Ability to work independently and collaboratively in a team environment. - Understanding of insurance policies, regulations, and industry standards.