Claims Examiner

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• Claims Processing and Assessment:
  • Evaluate incoming claims to determine eligibility, coverage, and validity.
  • Conduct thorough investigations, including reviewing medical records and other relevant documentation.
  • Analyze policy provisions and contractual agreements to assess claim validity.
  • Utilize claims management systems to document findings and process claims efficiently.
• Communication and Customer Service:
  • Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements.
  • Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process.
  • Address customer concerns and elevate complex issues as needed.
• Compliance and Documentation:
  • Ensure compliance with company policies, procedures, and regulatory requirements.
  • Maintain accurate records and documentation related to claims activities.
  • Follow established guidelines for claims adjudication and payment authorization.
• Quality Assurance and Improvement:
  • Identify opportunities for process improvement and efficiency within the claims department.
  • Participate in quality assurance initiatives to uphold service standards and improve claim handling practices.
  • Collaborate with team members and management to implement best practices and enhance overall departmental performance.
• Reporting and Analysis:
  • Generate reports and provide data analysis on claims trends, processing times, and outcomes.
  • Contribute to the development of management reports and presentations regarding claims operations.

• Entry level

• Full-time

• Finance and Sales

• Software Development

Location:

Indiana, United States
Salary: $86,000.00-$