Insurance Claims Processor VA

Responsibilities

• Register new claims, verify policy coverage and set up claim files with accurate reserves.
• Review claim forms, invoices, medical reports and supporting documents for completeness and validity.
• Adjudicate straightforward claims within authority limits and refer complex or suspicious claims to adjusters.
• Request missing information from claimants, providers and repairers and follow up until received.
• Process claim payments, denials and partial settlements with clear written explanations.
• Maintain claims management system records, notes and status updates for every file.
• Identify potential fraud indicators and escalate them according to procedure.
• Handle HIPAA-protected health information and other personal data in line with privacy rules.
• Meet turnaround and quality targets and report on ageing claims.
• Support subrogation, recovery and audit requests with organised claim documentation.