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Insurance Claims Examiner

Job Description

Typical Duties and Responsibilities 

  • Determines covered medical insurance losses by studying provisions of policy or certificate. 
  • Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims. 
  • Documents medical claims actions by completing forms, reports, logs, and records. 
  • Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter. 
  • Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations. 
  • Maintains quality customer services by following customer service practices; responding to customer inquiries. 

Common Skills and Proficiencies 

  • Understanding of health insurance administration processes 
  • Strong attention to detail 
  • Knowledge of medical terminology 
  • Excellent interpersonal skills 

Frequently Required Credentials and Education 

  • GED or high school diploma (Bachelor’s degree preferred)

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Phone: 407.872.1521

Address: 301 East Pine Street
Suite 1150
Orlando, FL 32801

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