Claims Examiner

Strickland Insurance Group•Duluth, GA

About The Position

As a Claims Examiner, you will play a critical role in the insurance process by thoroughly reviewing and evaluating insurance claims to determine their validity and ensure compliance with policy terms. Your work will directly impact the accuracy and fairness of claim settlements, helping to protect the financial interests of both the insurance company and its clients. You will analyze detailed documentation, investigate claim circumstances, and collaborate with various stakeholders to resolve discrepancies or disputes. This position requires a keen eye for detail, strong analytical skills, and the ability to make sound decisions based on complex information. Ultimately, your efforts will contribute to maintaining the integrity and efficiency of the claims process within the organization.

Requirements

High school diploma or equivalent; associate or bachelor’s degree in a related field preferred.
At least 2 years of experience in insurance claims processing, examination, or a related role.
Strong understanding of insurance policies, claims procedures, and relevant regulatory requirements.
Proficiency in using claims management software and standard office productivity tools.
Excellent analytical, organizational, and communication skills.

Nice To Haves

Certification such as AIC (Associate in Claims) or CPCU (Chartered Property Casualty Underwriter).
Experience with specific types of insurance claims such as health, auto, or property insurance.
Familiarity with legal terminology and procedures related to insurance claims.
Demonstrated ability to handle complex or high-value claims effectively.
Advanced skills in data analysis and reporting.

Responsibilities

Review and assess insurance claims for accuracy, completeness, and compliance with policy guidelines.
Investigate claims by gathering and analyzing relevant information, including medical records, police reports, and witness statements.
Determine the legitimacy of claims and recommend approval, denial, or further investigation as appropriate.
Communicate with claimants, healthcare providers, and other parties to clarify information and resolve issues.
Document findings and decisions thoroughly in the claims management system to ensure transparency and audit readiness.
Collaborate with legal, underwriting, and fraud prevention teams when necessary to address complex or suspicious claims.
Stay current with industry regulations, company policies, and best practices to ensure compliance and quality standards.