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)
About us
Headquartered in Maitland, FL with our brokerage and marketing office in St. Petersburg, Anchor Benefit Consulting represents small to mid-size employers with their health plan designs and consumer driven products. Known for our boutique style services and plans, Anchor is committed to helping employers offer competitive, valuable health benefits to their most valued assets, their employees.
Anchor Benefit is a third-party administrator (TPA), retained by employers, to pay claims and assist with other plan administration and compliance.
Anchor Benefit is not an insurance company. The employer pays for the plan expenses not paid by plan participants.
Job Description
CLAIMS EXAMINER/AUDITOR
Position Summary
Positions in this function are responsible for claims evaluation, adjudication and customer service in accordance with agreed quality and production standards. Processes claims in a timely manner and complies with industry fair claims practices and applicable federal regulations concerning the processing of claims. Authorizes the appropriate payment or refers to claims manager for further review. Conducts data entry and re-work; analyzes and identifies trends and provides reports as necessary. Responsible for ensuring a high level of customer service and maximizing productivity while cultivating customer relationships.
Primary Responsibilities:
Required Qualifications:
Job Specifications
Knowledge, skills and abilities required for competent performance in the job:
Other Duties: Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
Work Environment
Additional Job Information:
Employment Type: Full-Time; Regular
Department: Claims
Schedule: Full-Time (40 hours/week)
Pay Level: $19 - $25
Job Level: Individual Contributor
Location: Maitland, FL
Shift: Monday through Friday; 8:00am – 5:00pm
Travel: None
Telecommuter: Flexible
Overtime Status: Non-Exempt
Start Date: Immediate
Relocation Provided: No
Language Preference: Bilingual (English/Spanish)
Benefit Conditions:
COVID-19 Precaution(s):
Work Remotely
Job Type: Full-time
Pay: $39,520.00 - $52,000.00 per year
Benefits:
Schedule:
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Work Location: In person
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