Claims Examiner

Firstsource; Oregon; Hybrid; USD 42,000 - 66,000; Full time

Job summary

Firstsource is seeking a Claims Examiner to join our team in a remote-capable role with a Dallas base reference. The ideal candidate will review claims, verify documentation, and determine eligibility according to policy guidelines while communicating with claimants and providers.

This position emphasizes accuracy, regulatory compliance, and the ability to mentor junior staff. You will handle diverse claims types, use claims management software, and maintain production and quality standards in a

Qualifications

• 1–2 years of experience in claims examination or a related role.
• Experience handling health, auto, or property claims.
• Strong attention to detail and accurate documentation.
• Bilingual English/Spanish preferred.
• Ability to work independently in a fast-paced environment.
• Knowledge of regulatory requirements for claims.

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.

Skills

Claims processing knowledge

Claims management software

Attention to detail

Communication skills

Independent work

Bilingual English/Spanish

Fast-paced environment

Production and quality standards

Tools

Claims management software

Job description

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