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Title

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Claims Examiner

Description

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We are looking for a meticulous and detail-oriented Claims Examiner to join our team. In this role, you will be responsible for reviewing and analyzing insurance claims to determine their validity and ensure compliance with company policies and regulations. You will play a critical role in ensuring that claims are processed accurately and in a timely manner, while maintaining a high level of customer service. The ideal candidate will have strong analytical skills, excellent communication abilities, and a thorough understanding of insurance policies and procedures. As a Claims Examiner, you will collaborate with various departments, including underwriting and legal teams, to resolve complex claims and provide recommendations for claim settlements. Your ability to interpret policy language, assess damages, and identify potential fraud will be essential in this position. If you are passionate about delivering exceptional service and have a keen eye for detail, we encourage you to apply for this rewarding opportunity.

Responsibilities

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  • Review and analyze insurance claims for accuracy and completeness.
  • Determine the validity of claims based on policy terms and conditions.
  • Communicate with claimants, policyholders, and other stakeholders to gather necessary information.
  • Collaborate with underwriting and legal teams to resolve complex claims.
  • Identify potential fraud and escalate cases for further investigation.
  • Prepare detailed reports and documentation for claim settlements.
  • Ensure compliance with company policies, regulations, and industry standards.
  • Provide recommendations for claim approvals or denials.

Requirements

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  • Bachelor's degree in a related field or equivalent experience.
  • Strong understanding of insurance policies and procedures.
  • Excellent analytical and problem-solving skills.
  • Attention to detail and ability to work with complex data.
  • Effective communication and interpersonal skills.
  • Proficiency in relevant software and tools.
  • Ability to handle confidential information with integrity.
  • Previous experience in claims examination or a related role is preferred.

Potential interview questions

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  • Can you describe your experience with insurance claims processing?
  • How do you ensure accuracy and compliance when reviewing claims?
  • Have you ever identified and handled a fraudulent claim? If so, how?
  • What strategies do you use to manage multiple claims simultaneously?
  • How do you handle disputes or disagreements with claimants?