Job Description

Seeking a detail-oriented and analytical Claims Examiner to evaluate insurance claims, determine coverage, and ensure compliance with company policies and regulations. The ideal candidate will have customer service skills, excellent decision-making abilities, and experience handling claims in a fast-paced environment.

Responsibilities

• Review and process insurance claims to determine eligibility and validity.
• Investigate claims by gathering relevant information, including medical records, accident reports, and policy documents.
• Ensure claims comply with company policies, industry regulations, and legal requirements.
• Analyze claim details to determine appropriate settlements and make recommendations for approval or denial.
• Communicate with claimants, policyholders, legal representatives, and medical professionals to gather necessary documentation.
• Identify potential fraud and escalate suspicious claims for further investigation.
• Maintain accurate claim records and prepare detailed reports on findings and decisions.
• Collaborate with internal teams, including underwriting and legal departments, to resolve complex cases.
• Process claim payments within established timelines and ensure accuracy in calculations.
• Stay up to date with industry trends, regulatory changes, and best practices in claims management.

Qualifications

• Bachelor’s degree in Business, Insurance, Finance, or a related field (preferred).
• 2+ years of experience in a customer service.
• Strong analytical and problem-solving skills.
• Excellent attention to detail and ability to work with large volumes of data.
• Proficiency in claims management software and Microsoft Office Suite.
• Strong communication and negotiation skills.
• Ability to handle sensitive and confidential information with discretion.
• Certification or licensure as required by state regulations (e.g., Adjuster’s License).

Ascendo is a certified minority owned staffing firm, and we welcome and celebrate diversity.

Ascendo is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, parental status, military service or any other characteristic protected by federal, state or local law.

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