Claims Examiner II

Job Summary

Claims Examiner II is a full-time position responsible for receiving, researching, and reviewing allegations of fraud or abuse by beneficiaries and providers, including TRICARE eligibility issues and claim adjudications.

Key Responsibilities

• Review and assess incoming appeals to make accurate approval or denial decisions
• Organize case files and analyze documentation to support informed determinations
• Prepare detailed written decisions explaining the rationale for determinations

Required Qualifications

• U.S. citizenship is required due to Department of Defense restrictions
• High school diploma or equivalent
• 2 years or more in claims and customer service-related field working with the public
• Ability to learn and apply TRICARE regulations, policies, and procedures