Claims Examiner
Core
Evaluate and process insurance claims to determine payment, deferral, or denial based on policy provisions and regulations.
Role type
Claims Examiner
Builds
Claims decisions and customer correspondence
Domain
Insurance
Deliverable
client delivery
Required skills
Claims evaluation, Policy interpretation, Data entry, Claim investigations, Benefit calculations, Customer communication
Preferred skills
Analytical skills, Problem-solving, Attention to detail, Math proficiency, PC/Microsoft Office skills
Responsibilities
Evaluate claims against eligibility requirements, Enter and maintain accurate data in claims systems, Research and gather information for claim decisions, Perform benefit calculations, Communicate with internal and external customers, Participate in departmental meetings and training