Claims Examiner

Job Summary

Reviewing and processing insurance claims, the remote Claims Examiner will validate member and provider information, determine payment criteria, and maintain productivity goals while ensuring compliance with policies and procedures.

Key responsibilities

• Review and process insurance claims, ensuring accuracy and compliance with policies
• Validate member and provider information, determining payment criteria for pending claims
• Maintain productivity goals and quality standards while resolving complex situations as needed

Required qualifications

• University degree or equivalent with formal studies in English and basic math
• 6+ months of experience applying business rules and making decisions based on varying situations
• 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