Claims Examiner jobs in Cleveland, OH
Claims Examiner reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Additionally, Claims Examiner determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner work is closely managed. Works on projects/matters of limited complexity in a support role. To be a Claims Examiner typically requires 0-2 years of related experience. (Copyright 2024 Salary.com)
Recently Added Claims Examiner jobs
Claims Examiner
- Roundstone
-
Lakewood, OH
FULL_TIME
-
Bywater Claims ExaminerFounded in 2003, Roundstone is not your typical insurance company. We’re on a mission to help employers save on healthcare benefits so they can put those savings towards bettering their businesses and taking care of their employeesRole DescriptionAs a Bywater Claims Examiner you will review medical, dental, and vision claims to determine appropriate payment. This role requires the ability to accurately process claims in a timely manner and manage service requests. Bywater Claim Examiners are subject matter experts and are often asked to explain claim processing or review previously paid claims for accuracy. To be successful in this role, one must be flexible, able to see the big picture while paying attention to small details, and able to manage their time independently.Key Duties & Responsibilities:
- Ability to read, understand, and communicate medical benefits according to SPD language;
- Prompt and timely processing of claims accurately according to established expectations (150 claims per day);
- Process claims in accordance with benefit contracts, plan policies, and production/quality requirements;
- Prior to claim adjudication, establish proof of loss by reviewing and understanding medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting an investigation of questionable claims;
- Request and follow-up on additional information as needed for incomplete claims, including but not limited to COB, accident investigations, eligibility, etc.;
- Familiar with and understands various fee schedules;
- May include but are not limited to: processing claims, claim system testing, over/under payments and special projects.
Desired Qualifications:- Knowledge of TPA administrative services, policies, procedures and systems, testing of plan setup;
- 3 years experience processing Medical, Dental, Vision claims applying appropriate benefits;
- Certified in Medical Terminology I, II and ICD9/10 knowledge;
- Excellent verbal, communication, and written skills with strong organizational and research skills;
- Proficiency in Microsoft Office (Word, Excel and Access);
- Must be detail-oriented, have ability to work well under pressure, and handle multiple tasks with deadlines;
- Bilingual (English/Spanish) skills a plus.
Better Benefits:We’re leaders in our industry, so naturally, we look out for our employees’ best interests with a robust benefits package. Roundstone employees are eligible for:- Medical, dental and vision benefits
- Annual bonus
- Dependent care 100% match up to max allowable
- PTO beginning on Day 1
- Tuition reimbursement
- Health work/life balance
- Hybrid office schedule
- 401(k) plan with company match
- Employee Assistance Program
- On-site gym with personal trainer access
- Life insurance and short term disability insurance
More About RoundstoneHeadquartered in Lakewood, Ohio, Roundstone is regularly recognized as a Northeast Ohio Top Workplace by the Plain Dealer and cleveland.com. We are especially proud to be recognized as a Top Workplace since this honor is determined by anonymous feedback from our own employees. Roundstone employees enjoy a supportive workplace where they are engaged, valued and regularly recognized for their hard work at monthly company meetings. Roundstone’s core values are evident every day and are shared with the community through the sponsorship of community events and outreach.Our Core Values- Live well: Be healthier and bring positive energy to all you do.
- Work smarter: Get things done, better.
- Own it: Accountability is your middle name. Be on time, do what you say, and finish what you start.
- Be intellectually curious: Always be learning. See opportunity everywhere and have a drive to know.
Culture and fit are integral to success and in an effort to achieve a better match both from a candidate's perspective and our organization, please take a minute, click on the link and take the really brief survey:https://go.apply.ci/p/XoefKbRCMZnLDon't meet every single requirement? Studies have shown that women and people of color are less likely to apply to jobs unless they meet every single qualification. At Roundstone Insurance we are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles. - 19 Days Ago
Senior Claims Examiner - Workers Compensation
- Crawford & Company
-
Cleveland, OH
OTHER
- Excellence In Everything We Touch Position Summary Investigate and settle advanced, large loss, complex claims promptly and equitably under minimal supervision. Works within established authority on m...
- 15 Days Ago
Senior Claims Examiner - Workers Compensation
- Crawford & Company
-
Cleveland, OH
OTHER
- Excellence In Everything We Touch Position Summary Investigate and settle advanced, large loss, complex claims promptly and equitably under minimal supervision. Works within established authority on m...
- 15 Days Ago
Examiner Assistant / Examiner Associate
- Federal Reserve Bank of Cleveland
-
Cleveland, OH
FULL_TIME
- Company Federal Reserve Bank of Cleveland The Federal Reserve Bank of Cleveland is part of the nation’s central bank and we’ve provided many opportunities for professional growth during our history. W...
- Just Posted
Field Technician
- Hancock Claims Consultants
-
Cleveland, OH
CONTRACTOR
- CLIMB to New Heights… And live the_ American Dream. _Become part of something bigger by contracting with the nation’s top provider of roof and property inspection services working with insurance carri...
- 1 Month Ago
Mobile Medical Examiner
- NEO Medical Services
-
Lakewood, OH
PART_TIME
- The nation's fastest-growing paramedical services company, APPS Paramedical, is currently looking for medical professionals to perform mobile insurance examinations in the greater Cleveland area, with...
- 21 Days Ago
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0 Claims Examiner jobs found in Cleveland, OH area
Claims Examiner II
- Group Management Services, Inc.
-
Richfield, OH
- Group Management Services is looking for self motivated individual to step into our Claims Examiner II role based out of...
- 4/25/2024 12:00:00 AM
Claims Examiner -Remote
- Generis Tek Inc
-
Cleveland, OH
- Please Contact: To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Abhinav Chakraborty ...
- 4/25/2024 12:00:00 AM
Claims Examiner –Remote
- Generis Tek Inc
-
Cleveland, OH
- Please Contact: To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Abhinav Chakraborty ...
- 4/23/2024 12:00:00 AM
Senior Auto Claims Examiner | Remote
- King's Insurance Staffing
-
Cleveland, OH
- Our client has been experiencing continued growth and seeking to add a Senior Auto Liability/Bodily Injury Claims Examin...
- 4/22/2024 12:00:00 AM
Remote Insurance Agent
- Propel Personnel
-
Cleveland, OH
- Job Description Job Description Remote Insurance Agent Job Overview Join one of the nation’s leading Fortune 100 Insuran...
- 4/22/2024 12:00:00 AM
Insurance Agent
- Klutz Agency
-
Cleveland, OH
- As an insurance agent at the Klutz Agency, you are committed to helping families and individuals protect what matters mo...
- 4/21/2024 12:00:00 AM
Life Insurance Agent
- Barnes Agency
-
Mentor, OH
- Job Title: Life Insurance Agent Company Overview: Join our dynamic and rapidly growing team at the Barnes Family Agency,...
- 4/21/2024 12:00:00 AM
Licensed Insurance Agent
- Allstate Insurance Agency - Jenny Krainess
-
Cuyahoga Falls, OH
- Job Description Job Description Benefits: 401(k) matching Bonus based on performance Competitive salary Flexible schedul...
- 4/21/2024 12:00:00 AM
About Cleveland, Ohio
Cleveland (/ˈkliːvlənd/ KLEEV-lənd) is a major city in the U.S. state of Ohio, and the county seat of Cuyahoga County. The city proper has a population of 385,525, making it the 51st-largest city in the United States, and the second-largest city in Ohio. Greater Cleveland is ranked as the 32nd-largest metropolitan area in the U.S., with 2,055,612 people in 2016. The city anchors the Cleveland–Akron–Canton Combined Statistical Area, which had a population of 3,515,646 in 2010 and is ranked 15th in the United States.
The city is located on the southern shore of Lake Erie, approximately 60 miles ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Examiner jobs
$47,002 to $62,326
Cleveland, Ohio area prices
were up 1.6% from a year ago
were up 1.6% from a year ago