Senior Claims Examiner – Precision & Impact

Physicians Mutual; Omaha (NE); On-site; USD 55,000 - 75,000; Full time

Job summary

Physicians Mutual in Omaha, NE is seeking an experienced Senior Claim Examiner to manage an assigned caseload and guide policyholders and providers through the claim lifecycle.

The role requires analyzing and adjudicating claims, explaining coverage decisions clearly, and maintaining accurate claim documentation. Candidates should have 2+ years of claims handling experience and a solid knowledge of insurance policies and contract provisions.

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.
• Ability to manage an assigned caseload with accuracy, organization, and time management.
• Proficiency in claims systems and/or standard business software.

Responsibilities

• Manage an assigned claims caseload on an ongoing basis, ensuring timely processing.
• Review, analyze, and adjudicate claims according to policy provisions and company guidelines.
• Communicate claim decisions and next steps clearly via phone.
• Handle complex or escalated claim situations with 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 to explain coverage determinations clearly.

Skills

Analytical thinking

Communication skills

Claims knowledge

Education

Associate degree

Bachelor’s degree

Tools

Claims management software

Job description

Physicians Mutual in Omaha, NE is seeking an experienced Senior Claim Examiner to manage an assigned caseload and guide policyholders and providers through the claim lifecycle.

The role requires analyzing and adjudicating claims, explaining coverage decisions clearly, and maintaining accurate claim documentation. Candidates should have 2+ years of claims handling experience and a solid knowledge of insurance policies and contract provisions.