Claims Examiner

Job Summary

Reviewing and processing insurance claims, the full-time Claims Examiner will validate member and provider information, determine payment criteria, and maintain productivity goals while working remotely.

Key responsibilities

• Review and process insurance claims, ensuring accuracy and adherence to policy and procedure
• Validate claims information and determine payment criteria for pending claims
• Maintain productivity goals and quality standards while resolving complex situations following established guidelines

Required qualifications

• University degree or equivalent with formal studies in English and basic Math
• 6+ months of experience applying business rules to various situations and making decisions
• 6+ months of data entry experience focused on quality, accuracy, and accountability
• 6+ months of experience using Windows PC applications and learning new software tools
• 6+ months of experience prioritizing workload to meet deadlines