Claims Examiner I

Job Summary

A company is looking for a Claims Examiner I (Remote).

Key Responsibilities

• Process ongoing long-term care insurance claims and review related documentation for accuracy and eligibility
• Document policyholder accounts and correspondence, ensuring compliance with laws and regulations
• Identify potential fraud cases and refer plan of care changes to the Claim Management Department

Required Qualifications

• High school diploma or equivalent education and experience
• Minimum of two years' experience in processing and auditing claims
• Experience with medical records and reviewing claims
• Knowledge of long-term care insurance and claims processing regulations
• Ability to utilize software products and learn new systems effectively