Claims Examiner, Credit
On-siteJacksonville, Florida, United States
Job Summary
Review, evaluate, and adjudicate Credit Protection and Debt Cancellation claims by analyzing documentation to determine coverage eligibility, approve, pend, or deny outcomes per policy provisions. Accurately enter claim data into multiple systems while maintaining audit-ready files and navigating software applications simultaneously. Balance adjudication duties with inbound customer service support, handling approximately 40–60 calls on designated days to provide empathetic service regarding claim status and coverage decisions. Investigate potential fraud indicators and escalate concerns per established procedures. Maintain compliance with state regulations, privacy requirements including HIPAA, and internal operating procedures. Meet established productivity, quality assurance, and service level expectations while participating in training and quality reviews.
Required Qualifications
- High School Diploma or equivalent
- Minimum 2 years' experience in claims and/or other related claims processes
Desired Qualifications
- Experience reviewing documentation and making coverage or eligibility determinations preferred
- Strong customer service experience with the ability to effectively communicate verbally and in writing
- Experience handling confidential information while maintaining accuracy and attention to detail
- Fraud awareness and claims investigation experience preferred
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