Claims Examiner

2 weeks ago


Atlanta, Georgia, United States Jobot Full time
Job Title: Claims Examiner

Jobot is seeking a highly skilled Claims Examiner to join our team. As a Claims Examiner, you will be responsible for managing, investigating, and resolving claims in a timely and efficient manner.

Key Responsibilities:
  • Conduct thorough investigations into claims to determine validity and assess potential risks.
  • Utilize expertise in TPA Analysis to assess third-party administrators and their claims processing capabilities.
  • Identify and prevent fraudulent claims through proficiency in the fraud process.
  • Collaborate with the Claims Recovery team to ensure effective recovery of claim costs.
  • Prepare and present detailed reports on investigations, findings, and claim status.
  • Coordinate with legal counsel on claims requiring litigation.
  • Maintain accurate and up-to-date claim records.
  • Stay current with the latest industry trends, techniques, and methods related to claim examination and fraud detection.
  • Implement strategies to mitigate losses and protect the company's financial interests.
Requirements:
  • Bachelor's degree in Business Administration, Finance, or related field.
  • Minimum of 5 years of experience as a Claims Examiner, Claims Fraud Investigator, or similar role in the insurance industry.
  • Proven experience with TPA Analysis and Claims Recovery.
  • Excellent knowledge of the fraud process and experience in identifying and preventing fraudulent claims.
  • Strong analytical skills with the ability to interpret and process large amounts of data.
  • Exceptional attention to detail and accuracy.
  • Excellent verbal and written communication skills.
  • Strong organizational and multitasking skills.
  • Proficient in Microsoft Office Suite and claims management software.
  • Ability to work independently and as part of a team.
  • Certified Fraud Examiner (CFE) or similar certification would be an advantage.

Jobot is a leading global insurance organization that offers a competitive salary, comprehensive health, dental, and vision insurance plans, 401(k) retirement plan with company match, generous paid time off and holiday schedule, and employee wellness programs and resources. If you are a highly skilled and professional Claims Examiner looking for a challenging and rewarding role, please apply now by clicking the "Apply Now" button.



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