Claims Examiner in United States at Jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Claims Examiner based in United States.

The Claims Examiner plays a key role in ensuring accurate and timely evaluation of international insurance claims, supporting policyholders who rely on medical, dental, life, and travel coverage worldwide.
This role involves reviewing claims documentation, verifying policy eligibility, and determining coverage in accordance with insurance terms and regulatory standards.
You will work in a fast-paced, detail-oriented environment where accuracy, compliance, and customer service are essential.
The position requires strong analytical thinking to assess complex cases and identify when further investigation is needed.
You will collaborate with internal teams and external parties such as providers and claimants to gather and validate critical information.
Overall, this role directly contributes to delivering fair outcomes and maintaining trust in global insurance services.

• Review and evaluate insurance claims to determine coverage eligibility based on policy or certificate provisions.
• Analyze medical, dental, life, and travel-related claims, ensuring proper documentation and supporting evidence are obtained.
• Conduct investigations when claims require additional validation, coordinating with claimants, healthcare providers, and other stakeholders.
• Calculate claim benefits, approve or deny claims, and issue payments or denial communications accordingly.
• Maintain accurate records, documentation, and imaging queues in compliance with internal procedures and audit standards.
• Ensure all claim decisions comply with company policies as well as applicable state, federal, and insurance regulations.
• Deliver high-quality customer service while managing a productivity-driven workload.

• At least 1 year of experience in medical claims processing, or 2+ years in related fields such as medical billing, coding, claims research, benefits review, or insurance operations.
• Strong understanding of medical terminology and ability to interpret insurance policy or certificate language.
• Experience working with structured data, documentation, and claims systems in a high-volume environment.
• Strong analytical and problem-solving skills with attention to detail and accuracy.
• Ability to research, synthesize, and evaluate information from multiple sources to make informed claim decisions.
• Proficiency in basic computer tools, data entry, and standard office systems.
• Basic knowledge of ICD-10 and familiarity with healthcare regulations such as HIPAA is a plus.
• Strong communication skills, sound judgment, and ability to work independently in a fast-paced setting.

• Comprehensive medical, dental, vision, and prescription drug coverage.
• Life insurance coverage and additional protection benefits.
• 401(k) retirement plan with company match.
• Paid Time Off (PTO) and paid company holidays.
• On-site fitness center and free employee parking.
• Tuition reimbursement program for continued education and development.
• Casual work environment supporting employee comfort and flexibility.