Claims Examiner II
About The Position
The Claims Examiner is responsible for administratively reviewing, analyzing, and adjudicating claims of varying complexity. This role focuses on non-clinical decision making and ensures processing integrity by validating accuracy, completeness, eligibility, coverage, and benefit application across all claims systems. The Claims Examiner reviews supporting documentation, identifies discrepancies or potential fraud, resolves issues through coordination with internal and external stakeholders, and ensures all claim outcomes align with policy, regulatory requirements, and established procedures.
Requirements
- Proof of eligibility to work in the United States must be provided if selected for hire.
- Applicant must undergo a background check.
Responsibilities
- Administratively reviewing, analyzing, and adjudicating claims of varying complexity.
- Ensuring processing integrity by validating accuracy, completeness, eligibility, coverage, and benefit application across all claims systems.
- Reviewing supporting documentation.
- Identifying discrepancies or potential fraud.
- Resolving issues through coordination with internal and external stakeholders.
- Ensuring all claim outcomes align with policy, regulatory requirements, and established procedures.
Benefits
- Competitive base and incentive pay
- 401(k) with robust matching and non-matching contributions
- Rich medical & pharmacy benefits
- 100% employer-paid dental and vision benefits
- Holistic wellbeing program with deep financial incentives
- Generous paid time off plus 12 paid holidays and your birthday off
- Career development
- Tuition reimbursement
- Recognition program
- Adoption assistance
- Fertility treatment
- Child, elder & pet care assistance
- Social responsibility and volunteer opportunities
- Employee discount program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
1,001-5,000 employees
