Insurance Claims Examiner - Analytics & Customer Care

Firstsource Healthcare; United States; On-site; USD 40,000 - 60,000; Full time

Job summary

Firstsource Solutions in the United States seeks an experienced Claims Examiner to review and process insurance claims within the Health Plan and Healthcare Services function. You will analyze medical records, policy terms, and regulatory requirements while maintaining clear communication with claimants and stakeholders.

The role requires strong analytical skills and attention to detail, with knowledge of medical coding and claims software.

Qualifications

• Minimum 6 months to 1 year of medical/dental claims processing experience.
• Knowledge of medical terminology, ICD-9/ICD-10, CPT, HCPCS coding preferred.
• Understanding of HIPAA regulations and privacy requirements.

Responsibilities

• Review insurance claims to assess validity and policy adherence.
• Collect and analyze medical records, accident reports, and policy information.
• Ensure claims processing aligns with policies and regulatory requirements.
• Conduct investigations when needed and communicate with claimants and stakeholders.
• Determine liability, benefits, and appropriate settlement amounts.
• Provide timely processing and maintain organized claim files and records.
• Generate regular reports on claims processing status and trends.

Skills

Medical terminology

HIPAA regulations

Communication

Analytical skills

Claims processing software

Attention to detail

Education

High School diploma or GED

Tools

Claims processing software

Job description

Firstsource Solutions in the United States seeks an experienced Claims Examiner to review and process insurance claims within the Health Plan and Healthcare Services function. You will analyze medical records, policy terms, and regulatory requirements while maintaining clear communication with claimants and stakeholders.

The role requires strong analytical skills and attention to detail, with knowledge of medical coding and claims software.