Claims Examiner

The Claims Examiner position is responsible for evaluating and processing claims by performing all functions required to determine whether a claim is payable, deferred, or declined. This position ensures claims are handled in accordance with policy provisions, regulatory requirements, and company guidelines, while providing timely and professional correspondence to internal and external customers. In the Role Evaluate claims against eligibility requirements, provisions and applicable processesEnter and maintain accurate data in claims processing systems, including written correspondenceResearch and gather additional information to support claim decisionsPerform benefit calculations and conduct claim investigationsCommunicate with internal and external customers via phone and written correspondenceMaintain positive customer relationships through professional and empathetic interactionsParticipate in departmental meetings, training activities, and continuous improvement initiativesSupport occasional special projects and other duties as assigned Requirements High School diploma or equivalent requiredMinimum 2+ year of general work experienceStrong analytical and problem-solving skills with attention to detailAbility to evaluate claims against eligibility requirements and interpret policy languageEffective verbal and written communication skillsBasic math skills and proficiency in a PC environment, including Microsoft OfficeAbility to build and maintain positive customer relationships