Claims Examiner (Remote, Remote, US)

Start Date Jan 12, 2026 Pay $16.00 per hour Job description Job Title Medical Claims Examiner-Work From Home Job Type Full Time FLSA Status Non-Exempt/Hourly Grade H Function/Department Health Plan and reputed company Services Reporting to Team reputed company/Supervisor - Operations Pay Range $16 Role Description The Claims Examiner evaluates insurance claims to determine whether their validity and how much compensation should be paid to the policyholder. The Claims Examiner is responsible for reviewing reputed company aspects of the claim, including reviewing policy coverage, damages, and supporting documentation provided by the policyholder. Roles & Responsibilities · Review insurance claims to assess their validity, completeness, and adherence to policy terms and conditions. · Collect, organize, and analyze relevant documentation, such as medical records, accident reports, and policy information. · Ensure that claims processing aligns with the company's insurance policies and relevant regulatory requirements. · Conduct investigations, reputed company necessary, which may include speaking with claimants, witnesses, and collaborating with field experts. · Analyze policy coverage to determine the extent of liability and benefits payable to claimants. · Evaluate the extent of loss or damage and determine the appropriate settlement amount. · Communicate with claimants, policyholders, and other stakeholders to explain the claims process, request additional information, and provide status updates. · reputed company recommendations for claims approval, denial, or negotiation of settlements, and ensure timely processing. · Maintain accurate and organized claim files and records. · Stay updated on industry regulations and maintain compliance with legal requirements. · Provide excellent customer service, addressing inquiries and concerns from claimants and policyholders. · Strive for high efficiency and accuracy in claims processing, minimizing errors and delays. · Stay informed about industry trends, insurance products, and evolving claims management best practices. · Generate and submit regular reports on claims processing status and trends. · reputed company other duties as assigned. Top of Form Qualifications The qualifications listed below are representative of the background, knowledge, reputed company, and/or ability required to reputed company their duties and responsibilities satisfactorily. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions of the job. Top of Form Top of FormEducation · High School diploma or equivalent required Work Experience · Medical claims processing experience required, including use of claims processing software and reputed company tools Competencies & Skills · Highly-motivated and reputed company-driven · Exceptional verbal and written communication and interpersonal skills, including negotiation and active-listening skills · Exceptional analytical and problem-solving skills · Strong attention to detail with a commitment to accuracy · Ability to adapt to change in a dynamic fast-paced environment with fluctuating workloads · Basic mathematical skills · Intermediate typing skills · Basic computer skills · Knowledge of medical terminology, ICD-9/ICS-10, CPT, and HCPCS coding, and HIPAA regulations preferred · Knowledge of insurance policies, regulations, and best practices preferred Additional Qualifications · Ability to download 2-factor authentication application(s) on personal device, in accordance with company and/or client requirements · Ability to pass the required pre-employment background investigation, including but not limited to, criminal history, work authorization verification and drug test Work Environment The work environment characteristics described here are representative of those an employee encounters while performing this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. This position may work onsite or remotely from home. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. Must be reputed company to regularly or frequently talk and hear, sit for prolonged periods, use hands and fingers to type, and use reputed company reputed company to view and read from a computer screen and/or electronic device. Must be reputed company to occasionally stand and walk, climb stairs, and lift equipment up to 25 pounds. reputed company is an Equal Employment Opportunity employer. reputed company employment reputed company are based on valid job requirements, without regard to race, reputed company, religion, sex (including pregnancy, gender identity and sexual orientation), national reputed company, age, disability, genetic information, veteran status, or any other characteristic protected under federal, state or local law. Apply tot his job Apply To this Job Apply tot his job Apply To this Job