Claims Examiner

Essential Job Functions
Enters insurance claims received electronically or in written form.
Answers incoming customer calls regarding claim processing. Documents claim and associated history.
Evaluates available information to validate straightforward basic claims. Verifies policyholder information, policy effective dates, premium status and verification of claim eligibility.
Sends claim form to claimant for updating, correction or completion.

Identifies need for additional information; contacts appropriate source to obtain needed information.
Verifies beneficiary or claimant information if claim is warranted. Identifies payment amount and obtains required management approvals for payment.
Processes payment.
Advises claimant of status and resolution of claim. Escalates claimant concerns as appropriate.
Basic Qualifications

High school diploma or G.E.D.

1 or more years of claims experience
Experience working with insurance and/or medical terminology
Experience working with appropriate claims processing procedures and documentation