Claims Examiner

OneMain Financial • Fort Worth, TX

9d

About The Position

The Claims Examiner evaluates and processes claims, performing the functions needed to determine whether a claim is payable, deferred, or declined. The role ensures claims are handled in accordance with policy provisions, regulatory requirements, and company guidelines, and provides timely, professional correspondence to internal and external customers.

The position evaluates claims against eligibility requirements and policy provisions, maintains accurate information in claims processing systems, researches information to support decisions, calculates benefits, and conducts investigations. It also involves customer communication and relationship-building, participation in departmental meetings and training, continuous improvement activities, and occasional special projects or other assigned duties.

Requirements

• High school diploma or equivalent.
• Minimum of 2 years of general work experience.
• Strong analytical and problem-solving skills, with attention to detail.
• Ability to evaluate claims against eligibility requirements and interpret policy language.
• Effective verbal and written communication skills.
• Basic math skills and proficiency in a PC environment, including Microsoft Office.
• Ability to build and maintain positive customer relationships.

Responsibilities

• Evaluate claims against eligibility requirements, provisions, and applicable processes.
• Enter and maintain accurate data in claims processing systems, including written correspondence.
• Research and gather additional information to support claim decisions.
• Perform benefit calculations and conduct claim investigations.
• Communicate with internal and external customers by phone and written correspondence.
• Maintain positive customer relationships through professional and empathetic interactions.
• Participate in departmental meetings, training activities, and continuous improvement initiatives.
• Support occasional special projects and perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED