Claims Examiner, Credit

Fortegra•Jacksonville, FL

2d•Onsite

About The Position

Responsible for providing professional customer service to insureds and accounts while adjudicating credit protection and debt cancellation claims. Allocates time between claim adjudication and claims customer service, reviewing submitted information, coverage, and documentation in a timely manner. The above cited duties and responsibilities describe the general nature and level of work performed by people assigned to the job. They are not intended to be an exhaustive list of all the duties and responsibilities that an incumbent may be expected or asked to perform.

Requirements

High School Diploma or equivalent.
2 years’ experience in claims and/or other related claims processes.
Customer Service training is imperative since we communicate verbally on the phone and in written correspondence.
Fraud Awareness training and Claims Experience required.

Nice To Haves

Insurance Certifications, designations or licenses preferred, not required.

Responsibilities

Enter and adjudicate claims by reviewing documentation and determining appropriate action (pay, pend, or deny) in accordance with policy provisions, exclusions, and eligibility criteria.
Dynamically allocating time between claim adjudication and inbound customer service based on business needs, handling approximately 40–60 calls on designated call days.
Ability to efficiently navigate and multitask across multiple screens and software platforms.
Investigate claims with potential fraud indicators and escalate findings in alignment with anti-fraud protocols.
Communicate with insureds, accounts, and vendors to obtain and validate required information.
Maintain complete, audit-ready documentation to support legal, regulatory, and internal review requirements.
Ensure adherence to state regulations, HIPAA privacy standards, and company compliance guidelines to support accurate and compliant claim handling.
Provide cross-functional support as needed, serving as a backup resource to other departments across customer service, claim adjudication, and administrative functions to ensure continuity of operations and service levels.