Claims Examiner

Job Summary

Working remotely in a full-time capacity, the Claims Examiner will process medical, dental, and vision claims while interpreting plan provisions and collaborating with various departments to resolve client concerns.

Key responsibilities

• Processes, denies, pends, or allows claims based on eligibility and plan documents
• Tracks and responds to customer inquiries and appeals, ensuring timely follow-up
• Maintains compliance with service standards and identifies trends affecting quality performance

Required qualifications

• High School Diploma or equivalent
• 1+ years of experience in clerical and customer service roles
• Proficiency in Microsoft Office and basic mathematical skills
• Familiarity with medical terminology and claims processing preferred
• Ability to work independently and manage multiple priorities effectively