Claims Examiner

Point C

. Adjudicate new claims and process adjustments, including denials upon receipt of additional information .

Posted 9/21/2026full-timeRemote • United StatesJuniorMid-Level💰 $19 - $22 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in insurance claims processing, including adjudication, appeals resolution, and compliance with plan policies. Proficient in utilizing claims administration systems and maintaining high standards of accuracy and confidentiality.

Highest-signal resume keywords

Insurance Claims ProcessingThird Party Administrator (TPA) ExperienceCPT and ICD-10 CodingHealthPac, El Dorado, Javelina, or VBA SystemsStrong Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationClaims Review ProcessesPlan Document InterpretationClaims Payment FinalizationFinancial Accuracy Standards

Soft Skills

Customer Service SkillsAbility to Work IndependentlyPrioritization and Multitasking

Tools & Technologies

Microsoft OfficeGeneral Computer Applications

Certifications & Qualifications

Associate Degree Preferred

Industry Keywords

Self-Funded Claims AdministrationSubrogationThird-Party LiabilityMedical Terminology

Tech Stack

Tools & technologies

VBA

About the role

Key responsibilities & impact

Adjudicate new claims and process adjustments, including denials upon receipt of additional information
Review and resolve appeals and subrogation/third-party liability cases
Manage individual inventory to ensure timely turnaround and production goals are met
Ensure claims are processed in accordance with stop loss contract terms
Respond to internal and external inquiries via email and other channels within established timeframes
Follow up on missing or incomplete information to ensure claims can be accurately processed
Maintain minimum production, financial, and procedural accuracy standards on a monthly basis

Requirements

What you’ll need

Experience with Third Party Administrator (TPA) or self-funded claims administration preferred
At least 2+ years of experience in insurance claims processing required
Experience reviewing and finalizing claim payments for accuracy in accordance with plan policies
Ability to interpret and apply plan documents to ensure accurate claims adjudication
Demonstrated understanding of both claim review processes and underlying benefit plan design
Experience with HealthPac, El Dorado, Javelina, or VBA systems preferred
Working knowledge of CPT and ICD-10 coding
Basic understanding of medical terminology
Strong communication and customer service skills
Proficiency in Microsoft Office and general computer applications
Ability to maintain confidentiality and comply with all company policies and procedures
Able to work independently with minimal supervision
Ability to prioritize, multitask, and work overtime as needed
Associate Degree Preferred

Benefits

Comp & perks

Comprehensive medical, dental, vision, and life insurance coverage
401(k) retirement plan with employer match
Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
Paid time off (PTO) and disability leave
Employee Assistance Program (EAP)