Claims examiner Job Description

Claims examiner Job Description Template

Claims examiners scrutinize insurance claims, verifying their validity and determining the payout amount. Responsibilities encompass investigating, analyzing, and resolving claims, ensuring fair and efficient claim settlements.

Responsibilities:

  • Review and process insurance claims
  • Verify accuracy and completeness of claim information
  • Investigate and resolve issues related to claims
  • Communicate with claimants, providers, and other parties involved in the claim process
  • Ensure compliance with regulatory requirements and company policies
  • Update claim files and databases with relevant information
  • Analyze and report on claim trends and patterns
  • Provide customer service and support to claimants and other stakeholders

Requirements:

  • Bachelor's degree in a related field or equivalent work experience
  • Knowledge of health insurance policies and coverage
  • Strong analytical and problem-solving skills
  • Attention to detail and ability to maintain accuracy while processing claims
  • Excellent communication skills, both written and verbal
  • Ability to work independently and as part of a team
  • Experience with claims processing software and systems
  • Familiarity with medical terminology and coding systems (e.g. ICD-10, CPT)