
Financial Claim Examiner
2 days ago
Job Summary
A claims processor is responsible for reviewing and evaluating customer claims, ensuring their accuracy, eligibility, and compliance with policies. This involves investigating claims, determining validity, and settlement amounts while maintaining detailed records.
Main Responsibilities:
- Review and evaluate customer claims submitted through various channels.
- Investigate claims to determine validity and eligibility based on policies and procedures.
- Gather and analyze supporting documentation to support claim decisions.
- Determine appropriate settlement amounts for valid claims.
- Maintain accurate and detailed records of all claim activities.
- Communicate effectively with customers regarding the status of their claims.
- Collaborate with team leads to resolve complex claims and escalate issues as needed.
- Identify and report potential fraud or abuse.
- Stay updated on relevant industry regulations and policy changes.
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