Clinical Claims Review Specialist
Deliver high-quality clinical oversight and expertise in the review of aged, part-paid, and disputed insurance claims. Utilize strong analytical skills to determine the clinical defensibility of claims, supporting the preparation of appeal correspondence to insurers.
Key Responsibilities and Deliverables
* Provide clinical input and justification to support formal appeal letters to insurers.
* Collaborate with consultants and clinical departments to clarify care pathways, coding rationale, and documentation.
* Maintain accurate records and audit trails for all claim reviews.
* Participate in internal audits by providing expert opinions on complex claims related matters.
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