Medical Claims Examiner Templates

There is a huge number of templates that someone in the Medical Claims Examiner role uses in their daily work. In this article, we’ll outline the main templates they use.

Documents & Spreadsheets

These templates are some of the most commonly used templates by a Medical Claims Examiner. Documents are often built in tools like Word, Google Docs, Notion & others while spreadsheets are often built in Excel, Google Sheets, Airtable & others.

1. Claim Evaluation Template
2. Claim Rejection Template
3. Claim Approval Template
4. Claim Denial Template
5. Claim Adjustment Template
6. Claim Payment Template
7. Claim Investigation Template
8. Claim Dispute Template
9. Claim Settlement Template
10. Claim Audit Template

Reports

Reports are often prepared by a Medical Claims Examiner to track business performance for themselves or for their management team. They can be created in a variety of tools and can be static or dynamic templates.

1. Monthly Claims Summary Report
2. Provider Payment Report
3. Claims Denial Report
4. Claims Rejection Report
5. Claims Aging Report
6. Claims Audit Report
7. Claims Accuracy Report
8. Claims Processing Time Report
9. Claims Appeals Report
10. Claims Fraud Report

SOPs

At the heart of businesses with solid systems and processes are SOPs (standard operating procedures). These should be living documents that outline what a Medical Claims Examiner does and how they do it.

1. New Claim Processing SOP
2. Claim Investigation SOP
3. Claim Documentation SOP
4. Claim Adjudication SOP
5. Claim Denial SOP
6. Claim Appeals SOP
7. Claim Payment SOP
8. Claim Reimbursement SOP
9. Claim Fraud Investigation SOP
10. Claim Audit SOP

Presentations

Medical Claims Examiner presentations can be delivered either to internal or external stakeholders. Often created in tools like PowerPoint, Google Slides, Canva, Adobe or others, they are important for visually communicating important business information.

1. Monthly Claims Analysis
2. Provider Performance Review
3. Fraud Detection and Prevention
4. Claims Processing Efficiency
5. Customer Satisfaction Survey Results

Legal Docs

There are several key times when a Medical Claims Examiner needs to create and complete legal documents. By using templates set up as documents, signable PDFs or esignature software templates, they can speed up this process.

1. Medical Authorization Form
2. Claim Denial Letter
3. Medical Release Form
4. Claim Reconsideration Letter
5. Insurance Appeal Letter

Health & Safety Templates

Health & Safety templates for a Medical Claims Examiner ensure that the correct forms are completed to protect from harm and record any incidents at work.

1. Incident Report Template
2. Safety Inspection Checklist Template
3. Employee Training Record Template
4. Hazard Identification Template
5. Emergency Response Plan Template

Calendars

Setting up Medical Claims Examiner calendars ensures that they can visually see what’s coming up and plan events successfully.

1. Monthly Claims Processing Calendar
2. Provider Payment Schedule Calendar
3. Claims Review and Audit Calendar
4. Claims Appeals and Disputes Calendar
5. Compliance and Regulatory Deadlines Calendar

Invoice Templates

Several types of Medical Claims Examiner invoice templates can be used and these are generally set up as Word docs, PDFs or accounting software templates.

1. Monthly Provider Invoice
2. Claims Payment Invoice
3. Reimbursement Invoice
4. Deductible Invoice
5. Co-payment Invoice

Survey Templates

For a Medical Claims Examiner to get insights related to the work they do, they need to send out Medical Claims Examiner surveys. These templates can be set up as documents, fillable PDFs or survey software templates.

1. Customer Satisfaction Survey
2. Provider Network Evaluation Survey
3. Claims Processing Efficiency Survey
4. Fraud Detection and Prevention Survey
5. Medical Billing Accuracy Survey

Meeting Agendas

Having premade Medical Claims Examiner meeting agenda and meeting notes templates can save time and ensure you run efficient meetings. They are usually set up in tools like Word, Google Docs, Notion & others.

1. Monthly Claims Review Meeting
2. Provider Network Evaluation Meeting
3. Claims Denial Analysis Meeting
4. Fraud and Abuse Prevention Meeting
5. Quality Assurance and Compliance Meeting

Budget Templates

To manage finances well, a Medical Claims Examiner would need to have budget templates they can used on a monthly, quarterly and yearly basis.

1. Monthly Expense Budget Template
2. Claims Payment Budget Template
3. Provider Network Budget Template
4. Claims Processing Budget Template
5. Customer Service Budget Template

Dashboards

Dashboards are a useful way for a Medical Claims Examiner to monitor business performance and they can be set up as static documents or dynamic online documents/views.

1. Claims Processing Efficiency Dashboard
2. Claims Denial Rate Dashboard
3. Provider Performance Dashboard
4. Claims Aging Dashboard
5. Customer Satisfaction Dashboard

Proposal Templates

For bidding or requesting work, a Medical Claims Examiner needs a boilerplate proposal template that they can use over and over again. These templates can be set up as documents, fillable PDFs or proposal software templates.

1. Monthly Claims Analysis Proposal
2. Fraud Detection and Prevention Proposal
3. Claims Process Improvement Proposal
4. Provider Network Evaluation Proposal
5. Customer Satisfaction Enhancement Proposal

Get Your Template Made

We’ve brought together some of the best template builders in the world to help people like you get your templates built. We’ve seen that using a solid set of templates in business will help you streamline your systems and processes. Whether you’d like your Medical Claims Examiner templates built in Word, Google Docs, Excel, Google Sheets, PDF, Notion, Airtable, Canva, PowerPoint or other software, we’re here to help. Request your template and we’ll get your request in the hands of a 3D Animator Template designer.

Medical Claims Examiner Templates