• Analyzes and processes insurance claims to ensure complete accuracy, compliance, and timely payment for all patient claims. • Evaluates the completeness and accuracy of claim forms, supporting documentation, and medical records. • Determines the reimbursement or payment amounts based on policy coverage, fee schedules, negotiated rates, or other applicable guidelines. • Ensures compliance with insurance regulations, industry standards, and internal policies when processing claims. • Investigates and resolves claim denials or rejections by conducting research, consulting policy guidelines, and communicating with relevant parties. • Analyzes claims data to determine coverage eligibility and compliance with regulatory requirements. • Generates reports on claims processing metrics and provides insights to improve efficiency, accuracy, and customer satisfaction. • Provides clear communication with patients to effectively resolve issues and ensure ongoing customer satisfaction. • Identifies potential fraudulent activities by conducting fraud detection analysis and collaborating with fraud investigation teams.