Medical Claim Inspector
れせぷとてんけんいん
Industry & Occupation
Classification
Summary
Medical Claim Inspectors check the content of medical fee claim forms (receipts) submitted by medical institutions, detect and correct errors in insurance point calculations or omissions in descriptions.
Description
Medical Claim Inspectors verify the point calculations for medical procedures, medications, and materials listed on medical fee claim forms, as well as the requirements for insurance coverage, and identify and correct errors or deficiencies. They utilize knowledge of the health insurance system and medical fee point tables, operate electronic claim software to perform tasks efficiently, collaborate with doctors, nurses, and medical clerks to gather additional information or request corrections, and support the medical institution's revenue assurance and appropriate claims to insurers. They are required to update their knowledge in line with medical fee revisions and system changes.
Future Outlook
With the progress of an aging society, demand for medical fee claim operations remains stable. While efficiency improves through digitalization and AI utilization, the expertise for final checks will continue to be required.
Personality Traits
High Concentration / Meticulous / Strong Sense of Responsibility
Work Style
Claim Outsourcing Company Work / Clinic Work / Hospital Work / Remote
Career Path
Medical Clerk → Medical Administration Leader → Medical Fee Claim Manager → Medical Affairs Staff
Required Skills
Electronic Claim Software Operation / Health Insurance System Knowledge / Medical Fee Points / Medical Terminology and Department Codes / Office Software
Recommended Skills
Communication Skills (Collaboration with Doctors and Nurses) / Database Basics / Medical Administration / Medical Terminology (English)
Aptitudes (Strengths Preferred)
| Item | Description |
|---|---|
| Attention to Detail & Accuracy | Fine point errors are prone to occur, and accuracy is essential. |
| Learning Agility & Knowledge Acquisition | It is necessary to master the system with each medical fee revision. |
Aptitudes (Weaknesses Acceptable)
| Item | Description |
|---|---|
| Creativity & Ideation | The work mainly follows established rules, so originality is not required. |
| Physical Stamina & Endurance | Mainly desk work with little heavy labor. |
Related Qualifications
- Medical Administration Skills Certification Exam
- Medical Fee Claim Certification Exam
- Medical Secretary Skills Test
Aliases
- Claim Reviewer
- Medical Fee Claim Clerk
Related Jobs
- Claim Creator
- Medical Clerk
- Medical Coder