Health Insurance Claims Clerk
けんこうほけんせいきゅうじむいん
Industry & Occupation
Classification
Summary
Clerical role in medical institutions that calculates health insurance reimbursements, creates and submits recepts. Manages claim data, coordinates with insurers, and supports appropriate medical expense payments.
Description
Health insurance claims clerks at medical institutions and clinics determine medical reimbursements for services such as consultations, medications, and tests, taking into account patients' insurance types and copayment ratios. They prepare and digitize recepts (medical reimbursement detail sheets) and submit them to insurers. Leveraging knowledge of social insurance and national health insurance systems, they perform calculations in line with the medical fee points table, check for calculation errors or record omissions, and collaborate with doctors and nurses to make corrections if necessary. They also review returns or audit results from insurers, handle resubmissions and inquiries, and contribute to appropriate reimbursement of treatment fees. Proficiency in electronic recept systems and medical clerical software is essential, along with workflow updates and training in response to legal amendments and fee revisions.
Future Outlook
Stable demand is expected due to increasing medical needs from an aging population. Efficiency improvements from online recepts and AI adoption will require even greater expertise and IT skills.
Personality Traits
Work Style
Clinic Employment / Hospital Employment / Part-time or Contract Work / Short-hour Work Available
Career Path
Medical Clerk → Medical Secretary → General Affairs and Accounting Staff → Medical Institution Office Manager
Required Skills
Knowledge of Social Insurance Systems / Medical Insurance Claims / Medical Reimbursement Claims Clerical Work / Recept Computer Operation
Recommended Skills
Aptitudes (Strengths Preferred)
| Item | Description |
|---|---|
| Attention to Detail & Accuracy | Because errors in claim data affect insurance claims. |
| Numerical & Quantitative Analysis | Necessary for calculations and code verification in determining medical reimbursements. |
Aptitudes (Weaknesses Acceptable)
| Item | Description |
|---|---|
| Creativity & Ideation | Primarily routine tasks, so creativity is not particularly required. |
| Physical Stamina & Endurance | Mainly sedentary work with low physical demands. |
Related Qualifications
- Medical Reimbursement Claims Clerical Ability Certification Exam
Aliases
- Medical Billing Clerk
- Medical Fee Claims Clerk
- Recept Clerk
Related Jobs
- Dispensing Pharmacy Clerk
- Medical Clerk
- Medical Secretary