Claims Coordinator

Overview

At Inova Care International , we are committed to delivering efficient and accurate health insurance solutions. We’re expanding our operations and seeking a Claims Coordinator to join our dynamic team. This role is central to ensuring claims are processed accurately, fairly, and in line with compliance standards while supporting providers and members with professionalism and care.

Role Overview

The Claims Coordinator is responsible for processing, analyzing, and managing claims in compliance with service level standards. The role involves validating benefit coverage, detecting discrepancies or fraud, coordinating with policyholders and providers, and resolving claim-related issues. The ideal candidate has sharp analytical skills, attention to detail, and the ability to work effectively in a fast-paced environment.

Key Responsibilities

• Process and analyze medical and billing reports (MBRs) and claims within service level agreements (SLAs).
• Verify eligibility, coverage limits, and documentation against benefit policies and fee schedules.
• Investigate potentially fraudulent or inconsistent claims and escalate as needed.
• Communicate with providers and policyholders regarding incomplete, denied, or partially approved claims.
• Prepare client payment summaries, claims data reports, and audit-ready documentation.
• Collaborate with internal teams to ensure compliance and efficiency.
• Maintain high accuracy and productivity while meeting daily and weekly targets.

Qualifications & Skills

What We Offer

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