Claims Examiner

Firstsource; United States; On-site; USD 45,000 - 70,000; Full time

Job summary

Firstsource Solutions is seeking a Claims Examiner to review insurance claims for validity and completeness. You will collect medical records, analyze policy information, and ensure processing aligns with regulatory requirements, including HIPAA regulations.

Strong analytical skills and effective communication are essential. Responsibilities include investigations, determining settlements, maintaining organized claim files, and generating periodic reports on processing status and trends.

Qualifications

• High School diploma or GED (required).
• FEP Health claims processing experience is a must.
• Knowledge of medical terminology and coding (ICD-9/ICD-10, CPT, HCPCS).
• HIPAA regulations familiarity.
• Proficient with claims processing software and PC applications.
• Strong analytical and problem-solving skills; excellent communication.

Responsibilities

• Review insurance claims to assess validity, completeness, and policy adherence.
• Collect and analyze medical records, accident reports, and policy information.
• Ensure claims processing aligns with policies and regulatory requirements.
• Conduct investigations with claimants, witnesses, and field experts.
• Analyze policy coverage and determine liability and benefits; determine settlement amounts.

Skills

Medical terminology

ICD-9/ICD-10

HIPAA regulations

Claims processing software

Analytical skills

Communication skills

Education

High School diploma or GED

Tools

PC applications

Job description

Select how often (in days) to receive an alert:

Date: Oct 14, 2026

Location: US

Requisition ID: 24283

Description:

About Firstsource

Firstsource Solutions is a leading provider of customized Business Process Management (BPM) services. Firstsource specialises in helping customers stay ahead of the curve through transformational solutions to reimagine business processes and deliver increased efficiency, deeper insights, and superior outcomes.

We are trusted brand custodians and long-term partners to 100+ leading brands with presence in the US, UK, Philippines, India and Mexico. Our ‘rightshore’ delivery model offers solutions covering complete customer lifecycle across Healthcare, Telecommunications & Media and Banking, Financial Services & Insurance verticals.

Our clientele includes Fortune 500 and FTSE 100 companies

Job Title: Claims Examiner

Job Type: Full Time

Grade: H

Function/Department: Health Plan and Healthcare Services

Reporting to: Team Leader -Operations

Pay Range: XXXXX

Role Description: We are seeking a highly-motivated and success-driven Claims examiner who combines exceptional analytical and problem-solving skills, with the ability to positively adapt to change in a dynamic fast-paced environment. It is also vital that you display exceptional verbal and written communication, negotiation and active-listening skills, as well as the ability to work effectively in an environment with fluctuating workloads.

Roles & Responsibilities

• Review insurance claims to assess their validity, completeness, and adherence to policy terms and conditions.
• Collect, organize, and analyze relevant documentation, such as medical records, accident reports, and policy information.
• Ensure that claims processing aligns with the company's insurance policies and relevant regulatory requirements.
• Conduct investigations when necessary, which may include speaking with claimants, witnesses, and collaborating with field experts.
• Analyze policy coverage to determine the extent of liability and benefits payable to claimants.
• Evaluate the extent of loss or damage and determine the appropriate settlement amount.
• Communicate with claimants, policyholders, and other stakeholders to explain the claims process, request additional information, and provide status updates.
• Make recommendations for claims approval, denial, or negotiation of settlements, and ensure timely processing.
• Maintain accurate and organized claim files and records.
• Stay updated on industry regulations and maintain compliance with legal requirements.
• Provide excellent customer service, addressing inquiries and concerns from claimants and policyholders.
• Strive for high efficiency and accuracy in claims processing, minimizing errors and delays.
• Stay informed about industry trends, insurance products, and evolving claims management best practices.
• Generate and submit regular reports on claims processing status and trends

Preferred Educational Qualifications

• High School diploma or GED

Work Experience

• FEP Health claims processing experience is a must

Competencies & Skills

• Knowledge in the following a plus:
  • medical terminology
  • ICD-9/ICS-10, CPT, and HCPCS coding
  • HIPAA regulations
  • PC applications and systems
• Ability to read and interpret general business correspondence, procedure manuals, and specific plan documents
• Basic mathematical skills
• Intermediate typing skills
• Multiple computer application usage experience
• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Proficient in using claims processing software and related tools.
• Detail-oriented with a commitment to accuracy.
• Knowledge of insurance policies, regulations, and best practices