Claims Examiner

Beacon Hill; Chicago (IL); Remote; USD 30,000 - 47,000; Full time

Benefits offered by this job

Remote work

Year-end contract

Job summary

Beacon Hill Staffing Group is hiring a Claims Examiner for a 100% remote, contract role through year-end. Responsibilities include evaluating claims for accuracy, gathering documents, determining coverage, and communicating with stakeholders.

You will analyze medical records, authorize payments or denials, and maintain detailed files in the system. Qualifications include a Bachelor's degree (preferred) and 2+ years in claims handling, with strong analytical, investigative, and communication

Qualifications

• Bachelor's degree preferred.
• 2+ years of experience in insurance claims handling or related operations.
• Experience reviewing medical, disability, life, or health claims preferred.
• Strong analytical, investigative, and decision-making skills.
• Ability to interpret insurance policies and coverage provisions.
• Excellent written and verbal communication skills.
• Strong attention to detail and organizational skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency with Microsoft Office Suite and claims management systems.
• Customer-focused mindset with a commitment to quality service.

Responsibilities

• Review and evaluate incoming insurance claims for accuracy, completeness, and eligibility.
• Investigate claims by gathering documentation, medical records, policy information, and supporting evidence.
• Determine coverage, liability, and claim outcomes based on policy provisions and company guidelines.
• Communicate with policyholders, healthcare providers, attorneys, brokers, and internal stakeholders regarding claim status and requirements.
• Analyze medical documentation and claim-related information to make informed decisions.
• Authorize claim payments, settlements, denials, or referrals as appropriate.
• Maintain accurate and detailed claim files within the claims management system.
• Identify potential fraud indicators and elevate concerns when necessary.
• Ensure compliance with insurance regulations, company policies, and service standards.
• Respond to inquiries and resolve claim issues in a timely and professional manner.
• Collaborate with internal teams to improve claims processes and customer experience.
• Monitor claim progress and manage a caseload efficiently while meeting productivity goals.

Skills

Analytical skills

Investigative skills

Communication skills

Detail oriented

Multitasking

Education

Bachelor's degree

Tools

Claims management system

MS Office

Job description

Beacon Hill is hiring! We have partnered with a health insurance company in hiring a Claims Examiner to start immediately. This position is 100% remote and is a contract role through the end of the year.

What You'll Do

• Review and evaluate incoming insurance claims for accuracy, completeness, and eligibility
• Investigate claims by gathering documentation, medical records, policy information, and supporting evidence
• Determine coverage, liability, and claim outcomes based on policy provisions and company guidelines
• Communicate with policyholders, healthcare providers, attorneys, brokers, and internal stakeholders regarding claim status and requirements
• Analyze medical documentation and claim-related information to make informed decisions
• Authorize claim payments, settlements, denials, or referrals as appropriate
• Maintain accurate and detailed claim files within the claims management system
• Identify potential fraud indicators and elevate concerns when necessary
• Ensure compliance with insurance regulations, company policies, and service standards
• Respond to inquiries and resolve claim issues in a timely and professional manner
• Collaborate with internal teams to improve claims processes and customer experience
• Monitor claim progress and manage a caseload efficiently while meeting productivity goals

Qualifications

• Bachelor's degree preferred
• 2+ years of experience in insurance claims handling, claims examination, claims adjudication, or related insurance operations
• Experience reviewing medical, disability, life, accident, health, or professional liability claims preferred
• Strong analytical, investigative, and decision-making skills
• Ability to interpret insurance policies and coverage provisions
• Excellent written and verbal communication skills
• Strong attention to detail and organizational skills
• Ability to manage multiple priorities in a fast-paced environment
• Proficiency with Microsoft Office Suite and claims management systems
• Customer-focused mindset with a commitment to quality service

Beacon Hill is an equal opportunity employer and individuals with disabilities and/or protected veterans are encouraged to apply.

California residents: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

Benefits Information:

Beacon Hill offers a robust benefit package including, but not limited to, medical, dental, vision, and federal and state leave programs as required by applicable agency regulations to those that meet eligibility. Upon successfully being hired, details will be provided related to our benefit offerings.