| Claims Examiner I |
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| Also referred to as: Claim Review and Settlement Examiner I, Insurance Claims Examiner I |
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| 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. Work is closely managed. Works on projects/matters of limited complexity in a support role. Typically requires 0-2 years of related experience. |
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| Similar Jobs: Medical Claims Examiner I, Disability Claims Examiner I, Claims Examiner IV, Claims Examiner III, Claims Examiner II, Disability Claims Examiner III, Claims Adjuster I - P&C, Claims Clerk I, Claims Supervisor I |
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| Level of Education: Claims Examiner I Salaries with an Associate's Degree, Claims Examiner I Salaries with a Bachelor's Degree, Claims Examiner I Salaries with a Master's Degree or MBA, Claims Examiner I Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Energy & Utilities, Financial Services, Healthcare, Insurance, MFG Nondurable, Retail & Wholesale, Transportation | |
