Claims Examiner

Job Summary

Evaluating and processing claims remotely, the full-time Claims Examiner will determine eligibility for benefits, perform necessary accounting entries, and communicate with policyholders and medical providers while ensuring accurate and timely claims processing.

Key responsibilities

• Evaluate claims to determine eligibility for benefits in accordance with policy contracts
• Process claims and perform necessary accounting entries to complete claims processing
• Communicate directly with policyholders, agents, and medical providers via various channels

Required qualifications

• Bachelor's degree or 1-2 years of related experience and/or training, or equivalent combination of education and experience
• Six months' experience in a Claims Department Data Entry & Mail Distribution Representative position or four years in a non-entry level position
• Minimum typing requirement of 50 wpm
• Knowledge of medical coding and terminology with a required score of 98% or better on the Medical Terminology exam
• Proficiency in Microsoft Office Suite at an advanced level