Claims Examiner

6 days ago


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

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

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.
  • Exhibit proficiency in the fraud process, identifying suspicious activity, and implementing procedures to prevent fraud.
  • 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.
  • A 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.

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