Claims Examiner

Job Summary

Reviewing and processing insurance claims, the full-time Claims Examiner will validate member and provider information, determine payment criteria, and ensure compliance with policies while working remotely.

Key responsibilities

• Review and process insurance claims, validating necessary information for accuracy
• Determine payment criteria for pending claims based on established policies and procedures
• Maintain productivity goals and quality standards while resolving complex situations according to guidelines

Required qualifications

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