Senior Claim Examiner

Physicians Mutual Insurance Company, Inc.•Omaha, NE

About The Position

We are seeking an experienced and detail-oriented Senior Claim Examiner to manage an assigned caseload and serve as a primary point of contact throughout the claim’s lifecycle. The role reviews, evaluates, and processes claims while providing clear guidance and support to policyholders, providers, and internal partners. The ideal candidate has strong analytical skills and sound judgment, along with strong verbal and written communication skills, including exceptional phone communication abilities. The role requires confidently handling complex conversations, clearly explaining coverage determinations, accurately documenting claim activity, and reading, interpreting, and applying insurance contract provisions when making claim decisions. Success requires adaptability, accuracy, and the ability to manage changing workloads in a fast-paced environment.

Requirements

High school diploma required.
Strong knowledge of insurance policies, claims processes, and regulatory requirements.
Strong written and verbal communication skills, including the ability to explain complex information clearly and manage sensitive conversations professionally.
Ability to demonstrate critical thinking skills to evaluate claims accurately and consistently.
Ability to manage an assigned caseload with a high level of accuracy, organization, and time management.
Ability to work effectively in a fast-paced environment with shifting priorities.
Ability to handle confidential information with discretion and professionalism.
Proficiency in claims systems and/or standard business software.
Ability to work independently and collaborate effectively with internal teams.

Nice To Haves

Associate or bachelor’s degree preferred.
2+ years of claims handling experience or related insurance industry experience preferred.

Responsibilities

Manage an assigned claims caseload on an ongoing basis, ensuring timely and accurate processing.
Review, analyze, and adjudicate claims according to policy provisions and company guidelines.
Communicate claim decisions, requirements, and next steps clearly and professionally via phone.
Handle complex or escalated claim situations with confidence and sound judgment.
Maintain consistent follow-up with policyholders, beneficiaries, providers, and internal departments.
Document all claim activity thoroughly and accurately in the claims management system.
Interpret policy language and explain coverage determinations in a clear, understandable manner.
Identify potential issues, discrepancies, or risks and escalate as appropriate.
Maintain compliance with regulatory requirements and internal quality standards.
Meet productivity, quality, and service level expectations.