Talent.com
Peyton Resource Group
Claims ExaminerPeyton Resource Group • San Antonio, TX, US
Claims Examiner

Claims Examiner

Peyton Resource Group • San Antonio, TX, US
30+ days ago
Job type
  • Full-time
  • Quick Apply
Job description
Position Summary
We are seeking a detail-oriented Claims Examiner & Support Specialist I to support healthcare claims operations through accurate claims processing, provider communication, and administrative support. This role is responsible for reviewing and adjudicating delegated claims, resolving inquiries, maintaining documentation, and supporting efficient claims workflows while delivering a high level of customer service.
Key Responsibilities
Claims Processing & Review
  • Review healthcare claim submissions for completeness, accuracy, and compliance with established guidelines.
  • Verify claim information and support delegated claims adjudication processes.
  • Process claims accurately and within required service timelines.
  • Maintain awareness of payer policies, procedures, and regulatory requirements.

Provider Support & Communication
  • Handle inbound calls from healthcare providers and stakeholders regarding claims inquiries.
  • Provide timely and professional support related to claim status, processing questions, and issue resolution.
  • Document all interactions and maintain accurate communication records.
  • Escalate or resolve claim concerns as appropriate.

Administrative & Operational Support
  • Perform data entry and maintain claims documentation and records.
  • Log disputes and assist with claim follow-up and resolution activities.
  • Process incoming claims correspondence and support department workflow.
  • Complete additional administrative duties and special projects as assigned.
Qualifications
  • High School Diploma or GED required.
  • Minimum 1 year of call center or customer service experience preferred.
  • Previous healthcare claims or claims adjudication experience preferred.
  • Experience in healthcare administration or claims operations is a plus.
Required Skills & Experience
  • Basic understanding of healthcare terminology, coding, and claims processing practices.
  • Strong attention to detail and data accuracy.
  • Excellent verbal and written communication skills.
  • Ability to adapt to changing procedures and priorities.
  • Proficiency with Microsoft Office (Outlook, Word, Excel, Teams).
  • Comfortable working with claims processing systems and performing high-volume data entry.
  • Typing proficiency of approximately 50 WPM preferred.
  • Strong customer service and relationship-building skills.
  • Ability to manage multiple priorities in a fast-paced environment.
Create a job alert for this search

Claims Examiner • San Antonio, TX, US

Similar jobs

Claims Examiner I

GuideWellSan Antonio, TX, United States
Full-time +1

Claim Examiner PositionWebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30years of experience building unique benefit solutions and managing customized health plans.... Show more

 • Promoted

Claims Analyst

University HealthSan Antonio, TX, United States
Full-time

POSITION SUMMARY/RESPONSIBILITIESAnalyze complex problems pertaining to claim payments, eligibility, other insurance, transplants and system issues that are beyond the scope of claim examiners and ... Show more

 • Promoted

Casualty Claims Specialist

First Chicago Insurance CompanySan Antonio, TX, United States
Full-time

At First Chicago Insurance Company, our employees are our biggest asset! It is our mission to attract and retain intelligent, motivated, ethical employees who strive for excellence and growth, and ... Show more

 • Promoted

Remote Workers' Comp Claims Administrator

The HartfordSan Antonio, TX, United States
Remote
Full-time

A national insurance company seeks a Workers' Compensation Claim Administrator for their San Antonio location.This role involves managing claims, leveraging internal resources, and delivering excep... Show more

 • Promoted

Insurance Agent (Base salary + Uncapped commissions)

Comparion Insurance AgencySan Antonio, TX, United States
Full-time

We are looking for a Sales Agent to join our team in our San Antonio office.Success in this role will require a strong local network and in-person relationship building in the community.This is an ... Show more

 • Promoted

Claims Specialist

Syntricate TechnologiesSan Antonio, TX, United States
Full-time

Claims SpecialistSan Antonio, TX Contract Role Description:Responsible for the recovery of subrogation claims from insurance carriers and self-insured entities.Ensure coverage has been properly app... Show more

 • Promoted

Commercial Insurance Adjuster

Allcat Claims ServiceSan Antonio, TX, United States
Full-time

We are seeking a highly skilled Commercial Insurance Adjuster to independently investigate, evaluate, and resolve complex commercial property, liability, and casualty claims taking personal ownersh... Show more

 • Promoted

Injury Claims Adjuster

USAASan Antonio, TX, United States
Full-time

At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice.We seek to be the #1 choice for the military... Show more

 • Promoted

Life Insurance Investigator

Syntricate TechnologiesSan Antonio, TX, United States
Full-time

Location: San Antonio, TX onsite.Able to execute Fraud Investigation Case consisting of four types of investigations: Claims Investigation/Life Annuity Investigation, Financial Crime/Fraud, Medicar... Show more

 • Promoted

Sales Agent, Insurance

Peyton Resource GroupSan Antonio, TX, United States
Full-time

The team is responsible for generating new business revenue on a monthly basis and consistently exceeding individual and team sales goals.This role is built for a true hunter mentality - someone wh... Show more

 • Promoted

Sr. Injury Claims Adjuster

USAASan Antonio, TX, United States
Full-time

At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice.We seek to be the #1 choice for the military... Show more

 • Promoted

Derivatives Specialist

Frost BankSan Antonio, TX, United States
Full-time

It's about being there and building trust.Are you known for your attention to detail and exceptional organizational skills? Do you like working with others and have a goal-oriented mindset? Are you... Show more

 • Promoted

Adjuster, Claims (Remote)

San Antonio StaffingSan Antonio, TX, United States
Remote
Full-time

Claims Adjustment SupportProvides support for claims adjustment activities including administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage ... Show more

 • Promoted

Insurance Verification

Urology San AntonioSan Antonio, TX, United States
Full-time

The Insurance Verification teammate is responsible for ensuring scheduled procedures are on the patient's insurance-covered list and/or the patient meets self-pay criteria.The Insurance Verificatio... Show more

 • Promoted

Claims Supervisor

SWBCSan Antonio, TX, United States
Full-time

SWBC is seeking a talented individual to supervise the staff and activities involved in the accurate processing of mortgage claims to include resolving complex claims, training employees, and overs... Show more

 • Promoted

Claims Analyst

Arrive LogisticsSan Antonio, TX, United States
Full-time

Arrive Logistics is a leading transportation and technology company in North America with plans to grow significantly year over year.Our success is a testament to our remarkable team and what we're... Show more

 • Promoted

VP Claims Inventory Mgmt. Operations

JPMorgan ChaseSan Antonio, TX, United States
Full-time

Vice President Fraud Operations, Fraud Customer Protection Services (FCPS).Join the team and provide day to day leadership, oversight and execution of the business plan to ensure alignment and sup... Show more

 • Promoted

Property Adjuster

Allcat Claims ServiceSan Antonio, TX, United States
Full-time

This position will be located based out of our San Antonio office or working remotely from home and provides property claims service to customers using multiple communication channels.Reviews, eval... Show more

 • Promoted

Subrogation Specialist

Syntricate TechnologiesSan Antonio, TX, United States
Full-time

High School Diploma or General Equivalency Diploma required, College degree preferred.Excellent organizational and time-management skills.Strong written and verbal communication skills.Strong criti... Show more

 • Promoted

Director of Claims

HealthTexas Primary Care DoctorsSan Antonio, TX, United States
Full-time

Job Purpose The Director of Claims is responsible for overseeing and directing delegated claims operations to ensure accuracy, compliance, and efficiency.A key accountability of this role is the re... Show more