Claims Examiner Job Description

Job summary 1

The Claims Examiner reports to the Supervisor of Claims. The claims Examiner is responsible for reviewing and processing medical, dental, vision, and electronic claims by state, federal, and health plan regulatory requirements, and department guidelines, as well as meeting established quality and production performance benchmarks to include research and review of applicable documentation. The Claims Examiner will thoroughly review, analyze, and research healthcare claims to identify discrepancies, verify pricing, confirm prior authorizations, and process them for payment. The position will assist in resolving issues from providers, customer service, member services, health plans, and other internal customers.

Duties & Responsibilities 1

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Requirements & Skills 1

Job summary 2

Our Claims department is currently seeking a Claims Examiner to manage and oversee file load involving simple to moderate complexity subrogation losses. Provides support, insight, and/or direction to field claims reps in the pursuit of subrogation through several methods including direct, arbitration, litigation, or collection. Includes communications with payers, attorneys, agents, and/or insureds on the cases to achieve a positive and fair outcome. Also includes administrative-type procedures instrumental to the Claims Recovery operations.

Duties & Responsibilities 2

Requirements & Skills 2

Job summary 3

The Claims Examiner maintains a full caseload of Professional Liability claims. The ideal candidate would have experience handling lawyers, accountants, miscellaneous professional liability claims, and/or healthcare claims. Analyzes and reviews claims for accuracy, completeness, and coverage. Prepares and maintains reports and records for processing.

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Job summary 4

We are searching for a Claims Examiner - someone who works well in a fast-paced setting. In this position, you will process and adjudicate claims received for reimbursement to Providers based on an extensive review, research, and a detailed format of claim processing procedures.

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Requirements & Skills 4

Job summary 5

We are looking for a full-time Claims Examiner. Primary duties will be to ensure claim payments are issued promptly and accurately under the terms of various Long Term Care policies (including Nursing Home, Assisted Living, and Home Health Care benefits). Obtain proof of loss documentation from claimants and care providers, analyze information against the policy provisions, and make an independent benefit eligibility determination using professional judgment, skill, and policy-interpretation experience.

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Requirements & Skills 5

Job summary 6

The Claims Examiner position is responsible for the investigation, adjustment, and settlement of Homeowner Property claims.

Duties & Responsibilities 6

Requirements & Skills 6

Job summary 7

The Claims Examiner reviews and evaluates paper & electronic claims for benefits in accordance with policy provisions

Duties & Responsibilities 7

Requirements & Skills 7

Job summary 8

The Claims Examiner reports to the Supervisor of Claims. The claims Examiner is responsible for reviewing and processing medical, dental, vision, and electronic claims by state, federal, and health plan regulatory requirements, and department guidelines, as well as meeting established quality and production performance benchmarks to include research and review of applicable documentation. The Claims Examiner will thoroughly review, analyze, and research healthcare claims to identify discrepancies, verify pricing, confirm prior authorizations, and process them for payment. The position will assist in resolving issues from providers, customer service, member services, health plans, and other internal customers.

Duties & Responsibilities 8

Requirements & Skills 8

Job summary 9

The Claims Examiner will process claims for employee benefits and other benefit plans.

Duties & Responsibilities 9

Requirements & Skills 9

Job summary 10

We are seeking a skilled Claims Examiner to handle claims at our growing, innovation-focused company. A qualified candidate will have strong estimating skills, can comfortably handle high-severity losses, and distill complex information for customers. You’ll be able to effectively communicate and negotiate across multiple parties, including customers, contractors, and public adjusters. This is a desk-based adjusting position. If you're interested in joining our growing Claims team, we'd love to hear from you.

Duties & Responsibilities 10

Requirements & Skills 10

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