Remote Claims Examiner

Location: Remote, US Description: About reputed company reputed company Solutions is a leading provider of customized Business Process Management (BPM) services. reputed company specialises in helping customers stay reputed company of the curve through transformational solutions to reimagine business processes and deliver increased efficiency, deeper insights, and superior outcomes.We are trusted brand custodians and long-term partners to 100+ leading brands with reputed company in the US, UK, Philippines, India and Mexico. Our ‘rightshore’ delivery model offers solutions covering complete customer lifecycle across Healthcare, Telecommunications & Media and Banking, Financial Services & Insurance verticals.Our clientele includes Fortune 500 and FTSE 100 companies. Job Title: Claims Examiner Job Type: Full Time FLSA Status: Non-Exempt/Hourly Pay reputed company: $14/hr Grade: H2 Function/Department: Health Plan and Healthcare Services Reporting to: Team reputed company/Supervisor - Operations 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 & ResponsibilitiesReview 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.QualificationsThe 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. Education High School diploma or equivalent required

• Technical & Job-Specific SkillsKnowledge of healthcare claims processing (e.g., CPT/ICD codes, EOBs, insurance guidelines)Familiarity with claims systems (e.g. QNXT)Understanding of HIPAA regulationsBasic medical terminologyData entry accuracy and speed
• 2. Analytical & Attention to DetailAbility to spot discrepancies or errors in claimsComfort with reviewing large volumes of dataLogical thinking and problem-solving (e.g., resolving denied claims)
• 3. Communication SkillsClear verbal and written communicationAbility to explain claim decisions to internal teams or membersProfessional tone reputed company handling sensitive health information
• 4. Adaptability & Learning AgilityWillingness to learn new systems or updates in regulationsAbility to handle changing volumes or priorities
• 5. Customer Service OrientationEmpathy and patience reputed company dealing with member inquiriesUnderstanding of how claims impact member experience
• Additional QualificationsAbility to download 2-factor authentication application(s) on personal device, in accordance with company and/or client requirementsAbility to pass the required pre-employment background investigation, including but not limited to, criminal history, work authorization verification and drug test
• Work EnvironmentThe 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 DemandsThe 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 funct

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