Claims Examiner, Credit

Fortegra; Jacksonville (FL); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Life insurance

Vision

Disability (short/long-term)

401(k)

Tuition assistance

Job summary

Fortegra in Jacksonville, FL is seeking a Credit Claims Examiner to adjudicate Credit Protection and Debt Cancellation claims while delivering excellent customer service. The role involves reviewing documentation, determining eligibility, and communicating decisions in accordance with policy provisions and regulatory requirements.

The position balances claim adjudication with inbound calls and requires strong communication, accuracy, and attention to detail.

Qualifications

• High School Diploma or equivalent.
• Minimum 2 years’ experience in claims.
• Experience reviewing documentation to determine coverage/eligibility.
• Strong customer service and communication skills.
• Experience handling confidential information including HIPAA considerations, where applicable.

Responsibilities

• Review, adjudicate Credit Protection and Debt Cancellation claims per policy and eligibility.
• Enter claim information into multiple systems accurately and promptly.
• Balance adjudication with inbound customer service (40–60 calls on designated days).
• Provide professional, empathetic service to customers, financial institutions, vendors, and partners.
• Investigate for potential fraud indicators and escalate per anti-fraud procedures.
• Maintain audit-ready claim files and ensure regulatory compliance.

Skills

Customer service

Claims processing

Attention to detail

Verbal/written communication

Education

High school diploma

Job description

Jacksonville, FL
10751 Deerwood Park Blvd
Suite 200
Jacksonville, FL 32256, USA

Jacksonville, FL
10751 Deerwood Park Blvd
Suite 200
Jacksonville, FL 32256, USA

The Credit Claims Examiner is responsible for delivering exceptional customer service while accurately adjudicating Credit Protection and Debt Cancellation claims. This role reviews claim documentation, determines coverage eligibility, and communicates claim decisions in accordance with policy provisions, regulatory requirements, and company guidelines

The position requires balancing claim adjudication with inbound customer service responsibilities based on business needs while maintaining quality, productivity, and compliance standards.

Minimum Qualifications:

• High School Diploma or equivalent.

Minimum 2 years’ experience in claims and/or other related claims processes.

Experience reviewing documentation and making coverage or eligibility determinations preferred.

Strong customer service experience with the ability to effectively communicate verbally and in writing.

Experience handling confidential information while maintaining accuracy and attention to detail.

Fraud awareness and claims investigation experience preferred.

Primary Job Functions:

• Review, evaluate, and adjudicate Credit Protection and Debt Cancellation claims by analyzing submitted documentation and determining the appropriate claim outcome (approve, pend, or deny) in accordance with policy provisions, exclusions, and eligibility requirements.
• Accurately enter claim information into multiple systems while maintaining complete and timely claim documentation.
• Balance claim adjudication responsibilities with inbound customer service support based on business needs, handling approximately 40–60 inbound calls on designated call days.
• Provide professional, empathetic, and solution-focused service to customers, financial institutions, vendors, and business partners regarding claim status, documentation requirements, and coverage decisions.
• Navigate multiple software applications simultaneously while maintaining productivity and accuracy.
• Investigate claims for potential fraud indicators and elevate concerns in accordance with established anti-fraud procedures.
• Obtain, validate, and analyze documentation necessary to support claim decisions.
• Maintain audit-ready claim files that support internal quality standards, regulatory compliance, and legal requirements.
• Ensure compliance with applicable state regulations, company policies, privacy requirements (including HIPAA where applicable), and internal operating procedures.
• Meet established productivity, quality assurance, customer experience, and service level expectations.
• Identify opportunities to improve processes, enhance operational efficiency, and elevate the customer experience.
• Participate in departmental meetings, training sessions, quality reviews, and continuous learning initiatives.
• Provide cross-functional support as needed, serving as a backup resource to other departments across customer service, claim adjudication, and administrative functions to ensure continuity of operations and service levels.

The above cited duties and responsibilities describe the general nature and level of work performed by people assigned to the job. They are not intended to be an exhaustive list of all the duties and responsibilities that an incumbent may be expected or asked to perform.

Full benefit package including medical, dental, life, vision, company paid short/long term disability, 401(k), tuition assistance and more

#LI-Onsite

Equal Opportunity Employer
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