Claims Examiner Job Description
As a Claims Examiner, you will be responsible for handling insurance claims and ensuring that they are processed efficiently and accurately. You will review claim applications, gather necessary information, and verify policy coverage. Additionally, you will communicate with policyholders, medical professionals, and other parties involved in the claims process.
Responsibilities
- Review insurance claims and process them accurately and in a timely manner
- Conduct investigations and gather relevant information to evaluate claim validity
- Verify policy coverage and determine the extent of insurance liability
- Communicate with policyholders, medical professionals, and other parties to gather additional information or clarify details
- Analyze documents, reports, and medical records to assess claim validity
- Make decisions regarding claim settlement or denial based on policy terms and regulations
- Process payments for approved claims and ensure accurate accounting
- Keep detailed records of claims, correspondence, and actions taken
- Stay updated on industry regulations, policy changes, and best practices related to claims processing
Qualifications
- Previous experience as a Claims Examiner or similar role in the insurance industry
- Excellent analytical and problem-solving skills
- Strong attention to detail and accuracy
- Knowledge of insurance policies, claims procedures, and industry regulations
- Ability to interpret and analyze medical records and other relevant documents
- Effective communication and interpersonal skills
- Proficient in using claims management software and tools
- Ability to work efficiently in a fast-paced and deadline-driven environment
- Strong organizational and time management skills
Skills
- Knowledge of insurance policies and claims procedures
- Analytical and problem-solving skills
- Attention to detail
- Effective communication
- Interpersonal skills
- Claims management software
- Medical record analysis
- Organizational skills
- Time management