Claims Examiner, Credit

Credit Claims Examiner

The Credit Claims Examiner is responsible for delivering exceptional customer service while accurately adjudicating Credit Protection and Debt Cancellation claims. This role reviews claim documentation, determines coverage eligibility, and communicates claim decisions in accordance with policy provisions, regulatory requirements, and company guidelines. The position requires balancing claim adjudication with inbound customer service responsibilities based on business needs while maintaining quality, productivity, and compliance standards.

Minimum Qualifications:

• High School Diploma or equivalent.
• Minimum 2 years' experience in claims and/or other related claims processes.
• Experience reviewing documentation and making coverage or eligibility determinations preferred.
• Strong customer service experience with the ability to effectively communicate verbally and in writing.
• Experience handling confidential information while maintaining accuracy and attention to detail.
• Fraud awareness and claims investigation experience preferred.

Primary Job Functions:

• Review, evaluate, and adjudicate Credit Protection and Debt Cancellation claims by analyzing submitted documentation and determining the appropriate claim outcome (approve, pend, or deny) in accordance with policy provisions, exclusions, and eligibility requirements.
• Accurately enter claim information into multiple systems while maintaining complete and timely claim documentation.
• Balance claim adjudication responsibilities with inbound customer service support based on business needs, handling approximately 4060 inbound calls on designated call days.
• Provide professional, empathetic, and solution-focused service to customers, financial institutions, vendors, and business partners regarding claim status, documentation requirements, and coverage decisions.
• Navigate multiple software applications simultaneously while maintaining productivity and accuracy.
• Investigate claims for potential fraud indicators and escalate concerns in accordance with established anti-fraud procedures.
• Obtain, validate, and analyze documentation necessary to support claim decisions.
• Maintain audit-ready claim files that support internal quality standards, regulatory compliance, and legal requirements.
• Ensure compliance with applicable state regulations, company policies, privacy requirements (including HIPAA where applicable), and internal operating procedures.
• Meet established productivity, quality assurance, customer experience, and service level expectations.
• Identify opportunities to improve processes, enhance operational efficiency, and elevate the customer experience.
• Participate in departmental meetings, training sessions, quality reviews, and continuous learning initiatives.
• Provide cross-functional support as needed, serving as a backup resource to other departments across customer service, claim adjudication, and administrative functions to ensure continuity of operations and service levels.

The above cited duties and responsibilities describe the general nature and level of work performed by people assigned to the job. They are not intended to be an exhaustive list of all the duties and responsibilities that an incumbent may be expected or asked to perform.

Additional Information:

Full benefit package including medical, dental, life, vision, company paid short/long term disability, 401(k), tuition assistance and more

Job Posting Disclaimer: Fortegra has recently been made aware of unauthorized communications regarding career opportunities by individuals not associated with Fortegra or our recruitment team. Fortegra will only contact you from the Fortegra domain address (@fortegra.com). If you receive a message from someone posing as a Fortegra recruiter via text message, WhatsApp, Telegram or other messaging platform, please report it as phishing and block the sender.

Fortegra is not accepting unsolicited resumes from search firms for this position. Please be aware of job fraud(s) all correspondence emails regarding your candidacy will come from our Fortegra.com email address. Thank you.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.