Claims Examiner

Job Summary

Verifying and resolving insurance claims, the full-time Claims Examiner will ensure accurate processing in compliance with company policies and regulations while working remotely.

Key responsibilities

• Review and validate claims for accuracy, completeness, and eligibility based on policy terms
• Analyze and adjudicate claims, calculating benefit amounts and composing denial letters as necessary
• Maintain accurate records of claims and address inquiries from clients and providers regarding the adjudication process

Required qualifications

• High school diploma or equivalent required
• Minimum 1 year of healthcare reimbursement or claims processing experience
• Ability to read and interpret company guidelines and government regulations
• Intermediate computer skills, including proficiency in email, databases, and spreadsheets
• Strong analytical and problem-solving skills