Claims Examiner

This position is 100% remote and is a contract role through the end of the year.

Responsibilities

• Review and evaluate incoming insurance claims for accuracy, completeness, and eligibility
• Investigate claims by gathering documentation, medical records, policy information, and supporting evidence
• Determine coverage, liability, and claim outcomes based on policy provisions and company guidelines
• Communicate with policyholders, healthcare providers, attorneys, brokers, and internal stakeholders regarding claim status and requirements
• Analyze medical documentation and claim-related information to make informed decisions
• Authorize claim payments, settlements, denials, or referrals as appropriate
• Maintain accurate and detailed claim files within the claims management system
• Identify potential fraud indicators and escalate concerns when necessary
• Ensure compliance with insurance regulations, company policies, and service standards
• Respond to inquiries and resolve claim issues in a timely and professional manner
• Collaborate with internal teams to improve claims processes and customer experience
• Monitor claim progress and manage a caseload efficiently while meeting productivity goals

Requirements

• Bachelor's degree preferred
• 2+ years of experience in insurance claims handling, claims examination, claims adjudication, or related insurance operations
• Experience reviewing medical, disability, life, accident, health, or professional liability claims preferred
• Strong analytical, investigative, and decision-making skills
• Ability to interpret insurance policies and coverage provisions
• Excellent written and verbal communication skills
• Strong attention to detail and organizational skills
• Ability to manage multiple priorities in a fast-paced environment
• Proficiency with Microsoft Office Suite and claims management systems
• Customer-focused mindset with a commitment to quality service

Benefits

Beacon Hill offers a robust benefit package including, but not limited to, medical, dental, vision, and federal and state leave programs as required by applicable agency regulations to those that meet eligibility.