Claims Examiner

Firstsource Healthcare; Dallas (TX); Ibrido; USD 52.000 - 76.000; Tempo pieno

Descrizione del lavoro

Firstsource Healthcare in Dallas seeks a detail-oriented Claims Examiner to join our team. The role involves reviewing claims for eligibility, resolving discrepancies, and communicating with claimants and providers to expedite processing.

The ideal candidate has experience in claims examination, proficiency with claims management software, and strong attention to detail. This position supports a remote-friendly, fast-paced environment with focus on accuracy and compliance.

Competenze

• Strong claims processing knowledge across health, auto, and property.
• Proficient with claims management software and tools.
• High attention to detail and accurate documentation.
• Excellent verbal and written communication.
• Ability to work independently and manage multiple priorities.
• Bilingual English/Spanish abilities.
• Maintain production and quality standards in a fast-paced setting.
• Adapt to regulatory changes in claims processing.

Mansioni

• Review and analyze claims to determine eligibility and policy compliance.
• Investigate discrepancies in documentation and verify information.
• Communicate with claimants, providers, and internal teams to move claims forward.
• Maintain accurate records of claims activities per policy and regulations.
• Identify trends to suggest process improvements and efficiency gains.
• Provide training and mentorship to junior staff on processing best practices.
• Stay updated on industry regulations and claims processing standards.
• Assist in developing and implementing claims policies and procedures.

Conoscenze

Claims processing

Software tools

Attention to detail

Communication

Independent work

Bilingual EN/ES

Fast-paced

Quality standards

Formazione

Experience in claims examination

Strumenti

Claims management software

Descrizione del lavoro

Job Description

Job Title: Claims Examiner

Location: Dallas, Remote (Volume)

Job Summary

We are seeking a detail-oriented and experienced Claims Examiner to join our dynamic

team. The ideal candidate will possess strong claims knowledge and a proven track record

in claims processing and analysis. This role is critical in ensuring the accuracy and

efficiency of claims handling, contributing to our commitment to exceptional service

delivery. Matrix pay per claim after training.

Responsibilities

• Review and analyze claims submissions to determine eligibility and compliance with policy guidelines.
• Investigate and resolve discrepancies in claims documentation, ensuring all necessary information is collected and verified.
• Communicate effectively with claimants, providers, and internal teams to facilitate the claims process.
• Maintain accurate records of claims activities and decisions in accordance with company policies and regulatory requirements.
• Identify trends and patterns in claims data to recommend process improvements and enhance operational efficiency.
• Provide training and mentorship to junior staff on claims processing and best practices.
• Stay updated on industry regulations and changes in claims processing standards.
• Assist in the development and implementation of claims policies and procedures.

Mandatory Skills

• Strong knowledge of claims processing, including understanding of various types of claims (e.g., health, auto, property).
• Proficient in claims management software and tools.
• Strong attention to detail and accuracy in documentation.
• Effective communication skills, both verbal and written.
• Ability to work independently and manage multiple priorities in a fast-paced environment.
• Bilingual- English/Spanish
• Able to work in a fast-paced environment
• Maintaining production and quality standards

Preferred Skills

• Familiarity with regulatory compliance related to claims processing.
• Knowledge of data analysis tools and techniques.

Qualifications

• Minimum of 1-2 years of experience in claims examination or a related role.

If you are a motivated professional with a strong background in claims and a passion for