Claims Examiner
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At a glance
Job overview
Firstsource is hiring a Claims Examiner. Firstsource is seeking a highly-motivated and success-driven Insurance Claims Representative. This role requires exceptional analytical and problem-solving skills, adaptability to change, and strong verbal and written communication. The ideal candidate will also demonstrate negotiation and active-listening skills, and the ability to manage fluctuating workloads effectively.
Key focus areas include Review insurance claims to assess validity, completeness, and adherence to policy terms., Collect, organize, and analyze relevant documentation, such as medical records and accident reports., and Ensure claims processing aligns with company policies and regulatory requirements..
Successful candidates bring High School Diploma/G.E.D.. Important skills include Analytical Skills, Adaptability, Negotiation, Active Listening, Reading Comprehension, and Detail Orientation. Preferred (not required): Problem-Solving Skills, Communication, Basic Mathematical Skills, and Intermediate Typing Skills.
Skills & qualifications
Skills
Qualifications
Full job description
Experience Required
None
Minimum Education Required
High School Diploma/G.E.D.
Compensation
$7.25 / hourly
Hours Per Week
40
Number Of Positions
1
Work Schedule and Shift Requirements
First (Day)
Job Description
Job Title: Claims Examiner
Job Type: Full Time
Grade: H
Function/Department: Health Plan and Healthcare Services
Reporting to: Team Leader -Operations
Pay Rate: $17/hr
Role Description: We are seeking a highly-motivated and success-driven Insurance Claims Representative who combines exceptional analytical and problem-solving skills, with the ability to positively adapt to change in a dynamic fast-paced environment. It is also vital that you display exceptional verbal and written communication, negotiation and active-listening skills, as well as the ability to work effectively in an environment with fluctuating workloads.
Roles & Responsibilities
Review insurance claims to assess their validity, completeness, and adherence to policy terms and conditions.
Collect, organize, and analyze relevant documentation, such as medical records, accident reports, and policy information.
Ensure that claims processing aligns with the company's insurance policies and relevant regulatory requirements.
Conduct investigations when necessary, which may include speaking with claimants, witnesses, and collaborating with field experts.
Analyze policy coverage to determine the extent of liability and benefits payable to claimants.
Evaluate the extent of loss or damage and determine the appropriate settlement amount.
Communicate with claimants, policyholders, and other stakeholders to explain the claims process, request additional information, and provide status updates.
Make recommendations for claims approval, denial, or negotiation of settlements, and ensure timely processing.
Maintain accurate and organized claim files and records.
Stay updated on industry regulations and maintain compliance with legal requirements.
Provide excellent customer service, addressing inquiries and concerns from claimants and policyholders.
Strive for high efficiency and accuracy in claims processing, minimizing errors and delays.
Stay informed about industry trends, insurance products, and evolving claims management best practices.
Generate and submit regular reports on claims processing status and trends
referred Educational Qualifications
High School diploma or GED
Preferred Work Experience
Health claims processing experience a plus
Competencies & Skills
Knowledge in the following a plus:
medical terminology
ICD-9/ICS-10, CPT, and HCPCS coding
HIPAA regulations
PC applications and systems
Ability to read and interpret general business correspondence, procedure manuals, and specific plan documents
Basic mathematical skills
Intermediate typing skills
Multiple computer application usage experience
Strong analytical and problem-solving skills.
Excellent communication and interpersonal skills.
Proficient in using claims processing software and related tools.
Detail-oriented with a commitment to accuracy.
Knowledge of insurance policies, regulations, and best practices
Job Type
Full time
Benefits Offered
Not specified
Veteran Preference
No
Place of Work
On-site
Requisition ID
23042
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