Claims Examiner

Schedule: Monday to Friday, 8:00 AM – 4:00 PM

*Work Setup: Hybrid (1–2 days on-site per week)

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Key Responsibilities:**

• Review and process standard or less complex insurance claims (electronic and written).

• Respond to customer inquiries regarding claim status; document interactions accurately.

• Validate claims by verifying policyholder details, effective dates, eligibility, and premium status.

• Request updates or corrections from claimants as needed.

• Research and obtain additional information from appropriate sources to complete claims.

• Calculate payments, secure necessary approvals, and process disbursements.

• Communicate claim resolutions and escalate concerns appropriately.

Qualifications:

Required:

• High school diploma or GED

• 2–3 years of relevant experience (claims processing, Medicaid/Medicare, or paralegal background)

• Proficiency with Microsoft Office and ability to navigate multiple systems/web-based tools

• Strong attention to detail and ability to analyze fine print and make sound decisions

• Excellent data entry and written communication skills

Preferred:

• Experience with insurance or medical terminology

• Claims processing or customer service experience in healthcare or legal settings

• Ability to handle confidential information with discretion

• Strong multitasking and organizational skills

Work Environment:

• Hybrid role in an office environment with occasional on-site presence required.

• Must be comfortable working independently and collaboratively within a team.

ID:8SR6Ct