Claims Examiner

This is a fully remote position, open to applicants in Florida, +1 more state.

📋 Description

• Evaluate submitted claims to identify incidents, assess applicable coverage according to policy terms, and compute eligible reimbursement benefits.

• Approve or reject claims in accordance with the terms and conditions of the insurance agreement.

• Notify customers of claim decisions via letter, email, or phone communication.

• Address customer inquiries regarding claim status, required documentation, or general information.

• Document claim decisions, notes, and actions within PeopleSoft.

• Collaborate with internal departments to gather or confirm missing or ambiguous claim information.

• Investigate discrepancies and escalate complex or questionable claims to the Team Leader.

• Dispatch claim forms to new customers as necessary.

• Utilize AI, machine learning, data analytics, and cloud-based tools responsibly, adhering to data governance, security, and ethical-use standards.

⛳️ Requirements

• A high school diploma or equivalent is required.

• A strong eagerness to learn, develop, and establish a long-term career.

• Previous experience in claims processing is advantageous but not mandatory.

• Exceptional attention to detail along with strong organizational skills.

• Outstanding written and verbal communication skills.

• Capability to work both independently and collaboratively in a team setting.

• Familiarity with PeopleSoft or similar claims management systems is beneficial.

• Candidates must reside in Virginia or Florida.

🏝️ Benefits

• Performance-based bonuses.

• Merit increases.

• Additional incentives based on individual and company performance.

• Personal and professional development courses.

• Targeted development programs.

• Opportunities for international mobility and career advancement.

• Work Well programs.

• Flexible arrangements for work-life balance.

• Health insurance.

• Dental insurance.

• Vision insurance.

• Retirement savings plans.

• Paid time off.

• Additional employee programs.