Health Insurance 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

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.