Question

instructions: select the most appropriate response. which is employed by a third - party payer and reviews health - related claims to determine whether charges are reasonable and medically necessary? a. health care provider b. health insurance specialist c. medical assistant d. claims examiner

Explanation:

A claims examiner is employed by a third - party payer (such as an insurance company). Their role is to review health - related claims. This review includes checking if the charges for medical services are reasonable (in line with industry standards and the nature of the service) and medically necessary (the service was required for the patient's health condition). A health care provider delivers medical services, a health insurance specialist may handle general insurance - related tasks like enrollment and customer service but not specifically claim reviews for charge reasonableness and medical necessity in the same detailed way as a claims examiner, and a medical assistant supports medical staff in a clinical setting.

Answer:

d. claims examiner