| Claims Examiner II |
 |
| Also referred to as: Claim Review and Settlement Examiner II, Insurance Claims Examiner II |
|
| Requirements and Responsibilities |
| Examines and adjudicates insurance claims to determine coverage, validity, and appropriate payment in accordance with policy terms and regulations. Reviews claim documentation, policy provisions, and supporting evidence to assess liability and exposure. Authorizes claim payments within established authority limits. Investigates questionable or complex claims and coordinates with adjusters, providers, or external parties as needed. Documents findings, decisions, and rationale clearly within the claims system. Ensures compliance with company guidelines, regulatory requirements, and service standards. Requires a bachelor's degree. Typically reports to a manager. Occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. Typically requires 2-4 years of related experience. |
| |
|
| |
| Similar Jobs: Disability Claims Examiner II, Medical Claims Examiner II, Claims Examiner I, Claims Examiner III, Claims Examiner IV, Disability Claims Examiner III, Claims Adjuster II - P&C, Claims Supervisor II, Claims Clerk II |
|
| Level of Education: Claims Examiner II Salaries with an Associate's Degree, Claims Examiner II Salaries with a Bachelor's Degree, Claims Examiner II Salaries with a Master's Degree or MBA, Claims Examiner II Salaries with a JD, MD, PhD or Equivalent |
|
|
| Industries: Business Services, Edu., Gov't. & Nonprofit, Energy & Utilities, Financial Services, Healthcare, Insurance, MFG Nondurable, Retail & Wholesale, Transportation | |
