Senior Claim Examiner

Physicians Mutual Insurance Company, Inc.; Omaha (NE); On-site; USD 65,000 - 90,000; Full time

Job summary

Physicians Mutual Insurance Company, Inc. is seeking a Senior Claim Examiner in Omaha, NE to manage an assigned caseload through the lifecycle of claims.

The role requires reviewing, evaluating, and processing claims, and clearly communicating coverage determinations to policyholders, providers, and internal partners. The ideal candidate will have 2+ years of claims handling experience, strong written and verbal communication skills, and the ability to read, interpret, and apply insurance

Qualifications

• 2+ years of claims handling experience or related insurance industry experience preferred
• Strong written and verbal communication skills, including the ability to explain complex information clearly
• Ability to read, interpret, and apply insurance contract provisions when making claim decisions
• Proficiency in claims systems and standard business software
• Ability to manage an assigned caseload with accuracy and time management

Responsibilities

• Manage an assigned claims caseload on an ongoing basis, ensuring timely and accurate processing
• Review, analyze, and adjudicate claims according to policy provisions and company guidelines
• Communicate claim decisions, requirements, and next steps clearly via phone
• Handle complex or escalated claim situations with confidence and sound judgment
• Maintain consistent follow-up with policyholders, beneficiaries, providers, and internal departments
• Document all claim activity thoroughly and accurately in the claims management system
• Interpret policy language and explain coverage determinations in a clear, understandable manner
• Identify potential issues, discrepancies, or risks and elevate as appropriate
• Maintain compliance with regulatory requirements and internal quality standards
• Meet productivity, quality, and service level expectations

Skills

Claims handling experience

Communication skills

Contract interpretation

Attention to detail

Regulatory knowledge

Education

High school diploma

Associate or Bachelor's degree preferred

Tools

Claims systems

Job description

Overview

We are seeking an experienced and detail-oriented Senior Claim Examiner to manage an assigned caseload and serve as a primary point of contact throughout the claim’s lifecycle. This role is responsible for reviewing, evaluating, and processing claims while providing clear guidance and support to policyholders, providers, and internal partners.

The ideal candidate will demonstrate strong analytical skills, sound judgment, and strong verbal and written communication skills, including exceptional phone communication abilities. This position requires the ability to confidently handle complex conversations, clearly explain coverage determinations, accurately document claim activity, and read, interpret, and apply insurance contract provisions when making claim decisions. Success in this role requires adaptability, accuracy, and the ability to manage changing workloads in a fast-paced environment.

Responsibilities

• Manage an assigned claims caseload on an ongoing basis, ensuring timely and accurate processing
• Review, analyze, and adjudicate claims according to policy provisions and company guidelines
• Communicate claim decisions, requirements, and next steps clearly and professionally via phone
• Handle complex or escalated claim situations with confidence and sound judgment
• Maintain consistent follow-up with policyholders, beneficiaries, providers, and internal departments
• Document all claim activity thoroughly and accurately in the claims management system
• Interpret policy language and explain coverage determinations in a clear, understandable manner
• Identify potential issues, discrepancies, or risks and elevate as appropriate
• Maintain compliance with regulatory requirements and internal quality standards
• Meet productivity, quality, and service level expectations

Qualifications

• High school diploma required; associate or bachelor’s degree preferred
• 2+ years of claims handling experience or related insurance industry experience preferred
• Strong knowledge of insurance policies, claims processes, and regulatory requirements
• Strong written and verbal communication skills, including the ability to explain complex information clearly and manage sensitive conversations professionally
• Ability to demonstrate critical thinking skills to evaluate claims accurately and consistently
• Ability to manage an assigned caseload with a high level of accuracy, organization, and time management
• Ability to work effectively in a fast-paced environment with shifting priorities Ability to handle confidential information with discretion and professionalism
• Proficiency in claims systems and/or standard business software
• Demonstrate ability to work independently and collaborate effectively with internal teams

About Us

Health. Life. Retirement. The Physicians Mutual family empowers people from all walks of life to enjoy the financial security they deserve. That’s what Insurance for all of us is about.

The Physicians Mutual family includes Physicians Mutual Insurance Company, Physicians Life Insurance Company and Physicians Select Insurance Company. Physicians Mutual offers reliable dental and supplemental health insurance, and pet insurance. Physicians Life provides important life insurance, Medicare Supplement insurance and coverage for funeral pre-planning. Physicians Select Insurance Company additionally offers exclusive Medicare Supplement insurance.

Since our start in 1902, our dedication to delivering on our promise has helped make us one of the nation’s leading health and life insurance providers. In fact, we are rated in the top 1% of insurance companies. We consistently maintain some of the highest financial strength ratings in the nation from independent insurance analysts, including A.M. Best Company and Weiss Ratings, ensuring we’ll be there for our policyowners and our employees far into the future.

But the achievement we’re most proud of? We have a 95% customer satisfaction rating — a true sign of a company dedicated to embodying its vision.