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Claims Research

A Claims Researcher in the healthcare field works to review insurance claim files to ensure that carriers are exercising their practices in an efficient manner. The Claims Researcher works to produce reports on a daily, weekly, and monthly basis in order to summarize their findings.

Job Duties

  • Reviews claim files and reports on the performance levels of services provided by insurance carriers, using a thorough understanding of insurance adjusting practices
  • Ensures all claims are handled properly by maintaining a claims management diary system
  • Resolves any questions the client or patient may have in regards to the claims process, claims status, and settlements
  • Works to ensure that claim submissions that require research or special handling are processed efficiently
  • Reconciles claim reserves on a weekly basis to ensure proper tracking and reporting

Education and Experience

  • Generally, some college experience in a related field of study such as business or marketing is preferred
  • A valid Insurance Adjuster’s license is required
  • At least a year of insurance claims adjusting experience is required for most positions
  • Impeccable customer service, organizational, and analytical skills are a must
  • Possession of excellent written and verbal communication skills needed
  • A strong working knowledge of Microsoft Word and Excel is required