Medical Claims Processing Jobs: An Overview of the Role

Do you love connecting with people? Are you organized, self-motivated, and detail-oriented? A purposeful role that combines customer service skills with administration tasks, medical claims processing jobs are integral to our healthcare system and instrumental in getting people the right treatment when needed.

Better still, claims processing jobs can often be conducted remotely, and with so many benefits of maintaining the work-life balance that goes hand-in-hand with remote jobs, it’s a hard one to turn away.

This multifaceted role can vary greatly from company to company. Here at IQVIA, we have a whole range of medical biller job vacancies—more on that later. Depending on which company you look at, the role may be referred to as:

• Claims processing
• Medical claims processing
• Medical claims handling
• Medical claims billing
• Patient support medical claims processing representative

These names tend to be used interchangeably.

Generally speaking, if you’re a critical thinker, a people person, and someone who values a flexible yet stable career, working as a medical claims processing representative could be an excellent career choice that helps you live the kind of lifestyle you want.

Let’s tease out some of the main tasks that a medical claims processor may carry out in their line of work:

Job Description: What is the role of a medical claim handler?

1. Customer services

“What is the first step in processing a claim?”, you might ask. More often than not, it begins with the medical claims handler.

The primary role of a claim handler is to liaise between the patient and their insurer. The claim handler owes a duty of care to the patient, ensuring that their needs are being met and that they’re receiving the treatment or drugs they need.

This may involve speaking over the phone with patients, referring their cases to other professionals, offering advice on payment options and plans, retrieving and storing patient data, and providing general information about the healthcare system.

When a patient needs medical assistance, it’s often a medical claims processor that they first encounter. While AI is gaining traction in the medical claims world, patients value humans who can offer exceptional customer service skills. For anyone asking, “How can I improve my claims processing?”, improving their customer service skills is the natural first step.

2. Liaising with insurers

Do you love connecting with people? Communication is a fundamental part of the claims management process—particularly when it comes to insurance companies. The representative’s tasks may include reviewing paperwork related to a patient’s claim, ensuring it is all in order, and contacting their insurers when queries arise about the claim.

3. Investigating cases

Sometimes, a medical claims processor will have to look into claims where payment was denied. Commonly due to issues of insurance coverage eligibility, the claims handler may be tasked with reviewing documentation from the patient, their physicians, or the insurance company. This is where your eagle-eyed attention to detail and critical thinking skills will have their moment to shine.

The claims processor may need to serve as the go-between and provide explanations to the patient about the limitations of their insurance plan on behalf of the insurer.

4. Data management

Is being discreet one of your strong points? As a medical claims biller handles large volumes of sensitive data on an everyday basis, strong organization skills and confidentiality are key. The role may call for the use of particular data management software, spreadsheets, and medical history databases—all whilst making sure patients’ information stays private.

5. Administration

The role goes beyond pure data management—although that’s a big part of it. Common tasks assigned to a medical claims biller may include reviewing patient records, updating old information, processing payments, filing documents, submitting patient data to insurance companies, and communicating with stakeholders across the healthcare industry.

Discover the world of medical claims processor jobs

While the role of a claims handler varies greatly between companies, the general scope of tasks associated with the job is much the same. Typically, the role spans customer relations, data management, administration, and liaising with insurance companies.

IQVIA is currently recruiting medical claims processors in a variety of locations (as well as some remote opportunities). Explore our medical biller jobs page and discover the professional opportunities available today.