Medical Claims Specialist Examiner Skills

Running Topic: CRITICAL THINKING PAPER 3

 

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APA style. Must have 3 to 4 pages excluding the cover sheet and reference sheet.

Please include questions on the paper.

 

1. Does money motivate employees? Why or Why not?

2. Why should compensation systems be equitable? How can an organization design an equitable compensation system?

3. Compare and contrast the four job evaluation methods. Give an example of an organization in which each of the four methods might provide an optimal strategic fit.

4. Discuss the pros and cons of employee pay being fixed versus variable and dependent on performance. How might such decisions impact recruiting, motivation, and retention?

5. Analyze your current job responsibilities. Determine whether the method by which you are compensated appropriate.

6. Is performance-based pay effective? Why or why not? How can performance-based pay systems be better designed to ensure optimal results?

7. What are the advantages and disadvantages of organizational policies that mandate pay secrecy? Consider this question from the perspective of managers, employees, and owners. Is pay secrecy a good practice?

8. What obstacles exist to developing pay-for-performance plans in the public sector? How can these obstacles best be overcome? Do public sector pay-for-performance plans differ from those found in the private sector?

 

 

 

For question 5

 

My job is a Medical Claims Examiner

I work as a Contractor: my pay is $16.00 an hour in Illinois.

 

Medical Claims Specialist Examiner Job Duties:

· Determines covered medical insurance losses by studying provisions of policy or certificate.

· Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims.

· Documents medical claims actions by completing forms, reports, logs, and records.

· Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter.

· Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.

· Maintains quality customer services by following customer service practices; responding to customer inquiries.

· Provides legal support by assembling documentation for settlement action.

· Protects operations by keeping claims information confidential.

· Prepares reports by collecting, analyzing, and summarizing information.

· Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.

· Accomplishes organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.

Medical Claims Specialist Examiner Skills and Qualifications:

Claims Adjustment, Financial Software, Documentation Skills, Data Entry Skills, Analyzing Information , Problem Solving, Verbal Communication, Customer Focus, FDA Health Regulations, General Math Skills, Statistical Analysis

 

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