Supplemental Health Claims Examiner

Job Summary

To support the timely adjudication of complex claims, the full-time remote Supplemental Health Claims Examiner will make accurate claim decisions for supplemental health products, proactively gather relevant information, and maintain compliance with regulatory standards.

Key responsibilities

• Make timely, accurate, and customer-focused claim decisions for various supplemental health products
• Gather and analyze relevant information from multiple sources, including healthcare providers and claimants
• Document claims comprehensively while maintaining departmental performance metrics

Required qualifications

• 1-3 years of relevant experience in claims examination or a related field
• Extensive knowledge of supplemental health products and policy interpretation
• Proficiency in reviewing medical records, itemized bills, and standard claim forms
• Ability to exercise initiative and independent judgment within established guidelines
• High school diploma required; further education preferred