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Title
Text copied to clipboard!Claims Examiner
Description
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We are looking for a meticulous and detail-oriented Claims Examiner to join our team. The ideal candidate will be responsible for reviewing and analyzing insurance claims to determine the extent of the insurance company's liability. This role requires a thorough understanding of insurance policies, medical terminology, and legal regulations. The Claims Examiner will work closely with policyholders, medical professionals, and legal teams to ensure that claims are processed accurately and efficiently. Key responsibilities include investigating claims, verifying information, and making decisions on claim approvals or denials. The successful candidate will have excellent analytical skills, strong communication abilities, and a commitment to providing exceptional customer service. This position offers the opportunity to work in a dynamic and fast-paced environment, where attention to detail and the ability to manage multiple tasks are essential. If you have a background in insurance, healthcare, or a related field, and are looking for a challenging and rewarding career, we encourage you to apply.
Responsibilities
Text copied to clipboard!- Review and analyze insurance claims for accuracy and completeness.
- Investigate claims to determine the extent of the insurance company's liability.
- Verify information provided by claimants and other sources.
- Communicate with policyholders, medical professionals, and legal teams.
- Make decisions on claim approvals or denials based on policy terms and conditions.
- Document findings and decisions in the claims management system.
- Ensure compliance with legal and regulatory requirements.
- Identify potential fraud and escalate suspicious claims for further investigation.
- Provide exceptional customer service to claimants and other stakeholders.
- Collaborate with other departments to resolve complex claims issues.
- Maintain up-to-date knowledge of insurance policies and industry trends.
- Prepare reports and summaries of claims activity.
- Participate in training and professional development opportunities.
- Assist in the development and implementation of claims processing procedures.
- Handle appeals and disputes related to claim decisions.
Requirements
Text copied to clipboard!- Bachelor's degree in a related field or equivalent work experience.
- Minimum of 3 years of experience in claims examination or a related role.
- Strong understanding of insurance policies and coverage.
- Excellent analytical and problem-solving skills.
- Attention to detail and accuracy in reviewing and processing claims.
- Effective communication skills, both written and verbal.
- Ability to work independently and as part of a team.
- Proficiency in using claims management software and other relevant tools.
- Knowledge of medical terminology and legal regulations.
- Strong organizational and time management skills.
- Commitment to providing exceptional customer service.
- Ability to handle sensitive and confidential information.
- Experience in identifying and investigating potential fraud.
- Ability to manage multiple tasks and prioritize effectively.
- Willingness to participate in ongoing training and professional development.
Potential interview questions
Text copied to clipboard!- Can you describe your experience with claims examination?
- How do you ensure accuracy and completeness when reviewing claims?
- What steps do you take to investigate a claim?
- How do you handle a situation where you suspect fraud?
- Can you provide an example of a complex claim you resolved?
- How do you stay up-to-date with changes in insurance policies and regulations?
- What strategies do you use to manage multiple tasks and deadlines?
- How do you handle disputes or appeals related to claim decisions?
- Can you describe a time when you provided exceptional customer service?
- What tools and software are you proficient in for claims management?