Claims Examiner

Aston Carter•Naperville, IL

1d•Hybrid

About The Position

The Claims Examiner is responsible for reviewing, investigating, and evaluating claims to determine eligibility, and for negotiating claim resolutions in compliance with internal policies and state regulatory requirements. This role manages a high volume of claims and focuses on accurate, timely payments to customers and providers while maintaining exceptional attention to detail and data integrity.

Requirements

Minimum of 1 year of recent office experience in data entry, processing, dispatch, claims, provider relations, or a similar administrative role.
Proficiency with Microsoft Office applications.
Strong computer skills and the ability to work efficiently in multiple systems, including a proprietary operating system.
Experience working in a fast-paced environment with changing priorities.
Consistently strong attendance and reliability.
Exceptional attention to detail with the ability to produce high-quality work with minimal to no errors.
Efficient and accurate typing skills.
Strong organizational skills with the ability to manage a high volume of claims and tasks.
Effective verbal and written communication skills, including the ability to influence and collaborate with others.
Ability to learn new processes and systems quickly.
Self-starter mindset with strong problem-solving skills and the ability to work both independently and as part of a team.
High school diploma or GED.

Nice To Haves

Experience with claims processing, claim review, or claims examination.
Background in customer service related to claims, invoicing, or reimbursements.
Experience with invoice processing, invoice entry, and general invoicing procedures.
Familiarity with reimbursement processing and an understanding that reimbursement payments allow very little margin for error.
Experience using Salesforce CRM for tracking and managing customer and claim information.
Demonstrated ability to adapt well to change in a dynamic, fast-paced environment.
Creative problem-solving skills and the ability to be persuasive and thorough when resolving issues.
Strong team-player attitude, including the ability to get along well with others, accept feedback, and apply it constructively.
Ability to take detailed notes and consistently use available resources to resolve questions and improve accuracy.

Responsibilities

Review, investigate, and evaluate claims to determine eligibility in accordance with policies and state regulatory requirements.
Ensure customers and providers receive timely and accurate payments.
Handle customer reimbursement requests with a high degree of accuracy, recognizing that reimbursement payments cannot be reversed.
Validate daily NHS wire payments and research and resolve any exceptions.
Manage the reconciliation of Customer Preferred Pricing transactions to ensure accurate billing and payment.
Assist customers and internal partners with inquiries regarding claim and reimbursement status.
Analyze and validate large volumes of claims data and accurately enter information into the proprietary operating system.
Perform data entry for invoices, including indexing invoices received via inbox and moving them to the appropriate location.
Process and track invoice entry and invoice-related transactions as needed.
Use Salesforce CRM and other systems to document, track, and manage claims and customer interactions.
Complete filing and other administrative support tasks as required.
Communicate effectively with internal and external customers, providing clear, professional responses and updates.
Adapt to changes in processes, systems, and priorities in a fast-paced environment.
Apply feedback constructively, take notes, and use available resources to improve performance and accuracy.
Collaborate with team members within the Claims Management Department to meet department goals and service-level expectations.