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successfactors

Claims Examiner

Firstsource
Remote, USA
Junior · 1–2 years experience
Remote
Discovered 4 days ago
Communication

Full Job Posting

Responsibilities

  • Review and analyze claims submissions to determine eligibility and compliance with policy guidelines.
  • Investigate and resolve discrepancies in claims documentation, ensuring all necessary information is collected and verified.
  • Communicate effectively with claimants, providers, and internal teams to facilitate the claims process.
  • Maintain accurate records of claims activities and decisions in accordance with company policies and regulatory requirements.
  • Identify trends and patterns in claims data to recommend process improvements and enhance operational efficiency.
  • Provide training and mentorship to junior staff on claims processing and best practices.
  • Stay updated on industry regulations and changes in claims processing standards.
  • Assist in the development and implementation of claims policies and procedures.

Mandatory Skills

  • Strong knowledge of claims processing, including understanding of various types of claims (e.g., health, auto, property).
  • Proficient in claims management software and tools.
  • Strong attention to detail and accuracy in documentation.
  • Effective communication skills, both verbal and written.
  • Ability to work independently and manage multiple priorities in a fast-paced environment.
  • Bilingual- English/Spanish
  • Able to work in a fast-paced environment
  • Maintaining production and quality standards Preferred Skills:
  • Familiarity with regulatory compliance related to claims processing.
  • Knowledge of data analysis tools and techniques.
  • Minimum of 1-2 years of experience in claims examination or a related role. If you are a motivated professional with a strong background in claims and a passion for

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