Senior Claims Examiner - SCE 0330 SS#01

Job Title: Senior Claims Examiner

Location: Remote
Job Type: Contract (3 Months, with possible extension)

Job Summary

We are seeking a detail-oriented Senior Claims Examiner to review and assess supplemental health claims. The ideal candidate will have experience in claims operations and the ability to analyze documentation, communicate effectively with stakeholders, and ensure accurate and timely claim processing while maintaining compliance with industry standards.

Key Responsibilities

• Review and assess supplemental health claims based on policy terms and conditions.
• Gather required documentation from claimants, medical professionals, and relevant sources (quantitative review).
• Analyze medical records, employment history, and related information to support claim decisions (qualitative review).
• Communicate with claimants regarding claim status and request additional information as needed.
• Collaborate with healthcare providers, employers, and stakeholders to ensure efficient claims processing.
• Maintain accurate records of all claim-related documentation within workflow systems.
• Prepare detailed reports and summaries for internal review and decision-making.
• Ensure confidentiality and compliance with data protection regulations.
• Adhere to company policies, industry regulations, and legal requirements.
• Conduct audits of claims files for accuracy, completeness, and compliance.
• Participate in training to stay updated on policies and procedures.

Minimum Qualifications

• High School Diploma or equivalent.
• Experience in claims operations such as group disability, employee benefits, workers’ compensation, claim management, overpayment recovery, or leave management.
• 6–18 months of experience in life insurance backend operations.

Preferred Skills

• Strong English communication skills (written and verbal).
• Proactive and clear communication style.
• Ability to multitask and manage time effectively.
• High attention to detail and accuracy.
• Ability to work under pressure and meet deadlines.
• Customer service-oriented mindset.
• Basic computer proficiency and typing speed of at least 40 words per minute.
• Knowledge of insurance processes and terminology.
• Energetic, flexible, and adaptable approach to work.

For more details reach at shubham.sharma@navitassols.com.