Claims Examiner

Job Description

Job Title: Claims Examiner

Location: Dallas, Remote (Volume)

Job Summary:

We are seeking a detail-oriented and experienced Claims Examiner to join our dynamic

team. The ideal candidate will possess strong claims knowledge and a proven track record

in claims processing and analysis. This role is critical in ensuring the accuracy and

efficiency of claims handling, contributing to our commitment to exceptional service

delivery. Matrix pay per claim after training.

Responsibilities:

• Review and analyze claims submissions to determine eligibility and compliance with

policy guidelines.

• Investigate and resolve discrepancies in claims documentation, ensuring all

necessary information is collected and verified.

• Communicate effectively with claimants, providers, and internal teams to facilitate

the claims process.

• Maintain accurate records of claims activities and decisions in accordance with

company policies and regulatory requirements.

• Identify trends and patterns in claims data to recommend process improvements

and enhance operational efficiency.

• Provide training and mentorship to junior staff on claims processing and best

practices.

• Stay updated on industry regulations and changes in claims processing standards.

• Assist in the development and implementation of claims policies and procedures.

Mandatory Skills:

• Strong knowledge of claims processing, including understanding of various types of

claims (e.g., health, auto, property).

• Proficient in claims management software and tools.

• Strong attention to detail and accuracy in documentation.

• Effective communication skills, both verbal and written.

• Ability to work independently and manage multiple priorities in a fast-paced

environment.

• Bilingual- English/Spanish

• Able to work in a fast-paced environment

• Maintaining production and quality standards

Preferred Skills:

• Familiarity with regulatory compliance related to claims processing.

• Knowledge of data analysis tools and techniques.

Qualifications:

• Minimum of 1-2 years of experience in claims examination or a related role.

If you are a motivated professional with a strong background in claims and a passion for