Claims Examiner

This is a fully remote position, open to applicants in Texas.

📋 Description

• Assess claims to establish eligibility for benefits in line with policy agreements.

• Manage claims processing in accordance with Company protocols.

• Execute necessary accounting entries to finalize claims processing.

• Utilize independent judgment and decision-making skills in claims evaluations.

• Engage with policyholders, PR Representatives, Marketing Specialists, claimants, agents, and medical providers through phone, e-mail, and written communication.

• Conduct all tasks with a high level of accuracy.

• Undertake additional responsibilities as required by the department.

⛳️ Requirements

• Bachelor's degree from an accredited four-year institution, or 1–2 years of relevant experience and/or training; or an equivalent combination of education and experience.

• At least six months of experience in a Claims Department Data Entry & Mail Distribution Representative role (LG4), or four years in a non-entry level position (LG4 or above).

• Minimum typing speed of 50 words per minute.

• High School diploma or equivalent qualification.

• Familiarity with medical coding and terminology; must achieve a score of 98% or higher on the Medical Terminology exam.

• Advanced proficiency in Microsoft Office Suite (Outlook, Excel, Word).

• Competence in performing intermediate arithmetic calculations.

• Strong organizational abilities and attention to detail.

• Exceptional written and verbal communication skills.

• Capacity to excel in a fast-paced environment while working independently with limited supervision.

• Positive, team-oriented demeanor with adaptability to changing circumstances.

• High technical aptitude with the ability to quickly learn new systems.

• Preferred knowledge of the insurance industry and experience in claims handling.

• For advancement to Claims Examiner II: one year in the Claims Examiner role plus successful completion of ICA Medical Aspects of Claims and ICA Life and Health Insurance Law, or five years in the Claims Examiner position; a score of 98% or higher on the Medical Terminology exam; and fully competent performance for the two preceding quarters.

🏝️ Benefits

• Competitive salary designed to reflect your skills and contributions.

• Comprehensive health, dental, and vision insurance options.

• Extensive life insurance benefits.

• Retirement plans including a pension scheme.

• Paid holidays and vacation time.

• Parental leave.

• Subsidized all-in-one subscriptions promoting fitness, mindfulness, nutrition, and sleep.

• Company-sponsored counseling for mental health, stress management, and work-life balance.

• Eligibility for continued education reimbursement.

• Company-funded FLMI and ICA courses.

• Discounted tickets for Texas Rangers games.