Claims Examiner

Job Summary

Evaluating insurance claims for validity and compensation, the full-time hourly Claims Examiner will review documentation, conduct investigations, and ensure compliance with insurance policies while working remotely.

Key responsibilities

• Review insurance claims for validity, completeness, and adherence to policy terms
• Collect and analyze relevant documentation, including medical records and accident reports
• Communicate with claimants and stakeholders to explain the claims process and provide updates

Required qualifications

• High School diploma or equivalent required
• Health claims processing experience, including use of claims processing software
• Knowledge of medical terminology, ICD-9/ICS-10, CPT, and HCPCS coding preferred
• Understanding of insurance policies, regulations, and best practices preferred
• Ability to pass a pre-employment background investigation