Claims Examiner, Sr. jobs in Cleveland, OH

Claims Examiner, Sr. reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner, Sr. 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, Sr. determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner, Sr. occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Claims Examiner, Sr. typically requires 2 -4 years of related experience. (Copyright 2024 Salary.com)

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Claims Examiner
  • Roundstone
  • Lakewood, OH FULL_TIME
  • Bywater Claims Examiner
    Founded 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 employees
    Role Description
    As 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 Roundstone
    Headquartered 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/XoefKbRCMZnL
    Don'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.
  • 18 Days Ago

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Claims Examiner
  • Sheakley Group, Inc
  • Cleveland, OH FULL_TIME
  • Summary: Non-case management staff responsible for supporting the case management process. Always works under direct supervision of a Nurse Case Manager and does not make clinical judgment. We offer e...
  • Just Posted

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Senior Claims Examiner - Workers Compensation
  • Crawford & Company
  • Cleveland, OH OTHER
  • Excellence In Everything We Touch Position Summary GREAT WORK FROM HOME CAREER OPPORTUNITY! Seeking candidates with experience handling Ohio Self-Insrured Workers Compensation claims! Investigate and ...
  • 2 Months Ago

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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...
  • 4 Days Ago

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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...
  • 19 Days Ago

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Master Plan Examiner
  • City of Cleveland
  • Cleveland, OH FULL_TIME
  • Master Plan ExaminerUnder the supervision of the designated Chief Building Official for the City of Cleveland and the Commissioner of the Division of Construction Permitting, reviews commercial and re...
  • 15 Days Ago

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0 Claims Examiner, Sr. jobs found in Cleveland, OH area

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Claims Associate
  • Sedgwick
  • Independence, OH
  • Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A c...
  • 3/28/2024 12:00:00 AM

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Water Restoration Technician
  • Integrated Restoration
  • Cleveland, OH
  • Job Description Job Description Water Restoration Technician Are you looking for the next step in your career? Are you l...
  • 3/28/2024 12:00:00 AM

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Assistant Hospitality Manager
  • LAZ Parking
  • Cleveland, OH
  • The LAZ Hospitality silo is a unique team within LAZ Parking dedicated to growth through operational and financial excel...
  • 3/27/2024 12:00:00 AM

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Structural Engineer
  • Robson Forensic
  • Cleveland, OH
  • Job Description Job Description Structural Engineer Do you want to use your training, education, and experience in a new...
  • 3/27/2024 12:00:00 AM

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Panel Representative (Hybrid)
  • Metlife Legal Plans
  • Cleveland, OH
  • Job Description Job Description MetLife Legal Plans is currently hiring Panel Representatives for our growing Panel team...
  • 3/27/2024 12:00:00 AM

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Quality Engineer
  • CCL Label, Inc.
  • Strongsville, OH
  • Job Highlights Job Title: Quality Engineer Job Summary: The quality engineer is responsible for investigating and troubl...
  • 3/26/2024 12:00:00 AM

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Physician (Internist/Family Medicine/Physical Medicine & Rehabilitation)
  • Department of Veterans Affairs
  • Cleveland, OH
  • Summary This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement ...
  • 3/26/2024 12:00:00 AM

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Criminal Investigator (Special Agent)
  • Department Of Homeland Security
  • Cleveland, OH
  • Summary Joining the Secret Service as a Special Agent will allow you to perform critical protective and investigative as...
  • 3/25/2024 12:00:00 AM

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, Sr. jobs
$61,317 to $79,053
Cleveland, Ohio area prices
were up 1.6% from a year ago

Claims Examiner, Sr. in Riverside, CA
Health Claims Examiners, or Health Information Technicians, enter data electronically to process transactions.
December 14, 2019
Claims Examiner, Sr. in Evansville, IN
If you’re in dire straits, we can advise you on steps to get the OWCP claims examiner to pay attention to your needs, such as contacting the Department of Labor’s district director, or the national director via mail.
February 12, 2020
Claims Examiner, Sr. in Springfield, IL
No, the examiner is only involved in performing the exam and providing the results to the claims processor.
January 13, 2020