Claims Examiner

About the job

About the Opportunity:

This role involves managing the claims process to ensure accurate assessment and timely resolution. The position supports the organization by evaluating claims, maintaining compliance, and improving operational efficiency.

Responsibilities:

• Evaluate incoming claims for eligibility, coverage, and validity

• Conduct investigations by reviewing medical records and relevant documentation

• Analyze policy provisions and contractual agreements to determine claim validity

• Use claims management systems to document findings and process claims

• Communicate with policyholders, beneficiaries, and healthcare providers about claim status and requirements

• Respond promptly to inquiries with professional and empathetic communication

• Address customer concerns and escalate complex issues to senior personnel as needed

• Ensure compliance with organizational policies, procedures, and regulatory requirements

• Maintain accurate records and documentation related to claims activities

• Follow guidelines for claims adjudication and payment authorization

• Identify opportunities for process improvement and efficiency within the claims department

• Participate in quality assurance initiatives to uphold service standards and improve practices

• Collaborate with team members and management to implement best practices and enhance performance

• Generate reports and analyze data on claims trends, processing times, and outcomes

• Contribute to management reports and presentations about claims operations

Note:

“RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.”