Claims Examiner

About Firstsource

Firstsource Solutions is a leading provider of customized Business Process Management

(BPM) services. Firstsource specialises in helping customers stay ahead of the curve through

transformational solutions to reimagine business processes and deliver increased efficiency,

deeper insights, and superior outcomes.

We are trusted brand custodians and long-term partners to 100+ leading brands with

presence in the US, UK, Philippines, India and Mexico. Our ‘rightshore’ delivery model offers

solutions covering complete customer lifecycle across Healthcare, Telecommunications &

Media and Banking, Financial Services & Insurance verticals.

Our clientele includes Fortune 500 and FTSE 100 companies.

Job Title: Claims Examiner-Work From Home

Job Type: Full Time

FLSA Status: Non-Exempt/Hourly

Grade: H

Function/Department: Health Plan and Healthcare Services

Reporting to: Team Lead/Supervisor - Operations

Pay Range: $14.00

Role Description: The Claims Examiner evaluates insurance claims to determine whether

their validity and how much compensation should be paid to the policyholder. The Claims

Examiner is responsible for reviewing all aspects of the claim, including reviewing policy

coverage, damages, and supporting documentation provided by the policyholder.

Roles & Responsibilities

• Review insurance claims to assess their validity, completeness, and adherence to policy

terms and conditions.

• Collect, organize, and analyze relevant documentation, such as medical records,

accident reports, and policy information.

• Ensure that claims processing aligns with the company's insurance policies and relevant

regulatory requirements.

• Conduct investigations, when necessary, which may include speaking with claimants,

witnesses, and collaborating with field experts.

• Analyze policy coverage to determine the extent of liability and benefits payable to

claimants.

• Evaluate the extent of loss or damage and determine the appropriate settlement

amount.

• Communicate with claimants, policyholders, and other stakeholders to explain the

claims process, request additional information, and provide status updates.

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• Make recommendations for claims approval, denial, or negotiation of settlements, and

ensure timely processing.

• Maintain accurate and organized claim files and records.

• Stay updated on industry regulations and maintain compliance with legal requirements.

• Provide excellent customer service, addressing inquiries and concerns from claimants

and policyholders.

• Strive for high efficiency and accuracy in claims processing, minimizing errors and

delays.

• Stay informed about industry trends, insurance products, and evolving claims

management best practices.

• Generate and submit regular reports on claims processing status and trends.

• Perform other duties as assigned.

Qualifications

The qualifications listed below are representative of the background, knowledge, skill,

and/or ability required to perform their duties and responsibilities satisfactorily. Reasonable

accommodations may be made to enable individuals with disabilities to perform the

essential functions of the job.

Education

• High School diploma or equivalent required

Work Experience

• Health claims processing experience required, including use of claims processing

software and related tools

Competencies & Skills

• Highly-motivated and success-driven

• Exceptional verbal and written communication and interpersonal skills, including

negotiation and active-listening skills

• Exceptional analytical and problem-solving skills

• Strong attention to detail with a commitment to accuracy

• Ability to adapt to change in a dynamic fast-paced environment with fluctuating

workloads

• Basic mathematical skills

• Intermediate typing skills

• Basic computer skills

• Knowledge of medical terminology, ICD-9/ICS-10, CPT, and HCPCS coding, and HIPAA

regulations preferred

• Knowledge of insurance policies, regulations, and best practices preferred

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Additional Qualifications

• Ability to download 2-factor authentication application(s) on personal device, in

accordance with company and/or client requirements

• Ability to pass the required pre-employment background investigation, including but not

limited to, criminal history, work authorization verification and drug test

Work Environment

The work environment characteristics described here are representative of those an

employee encounters while performing this job. Reasonable accommodations may be made

to enable individuals with disabilities to perform the essential functions.

This position may work onsite or remotely from home.

Physical Demands

The physical demands described here are representative of those that must be met by an

employee to successfully perform the essential functions of this job. Reasonable

accommodations may be made to enable individuals with disabilities to perform the

essential functions.

Must be able to regularly or frequently talk and hear, sit for prolonged periods, use hands

and fingers to type, and use close vision to view and read from a computer screen and/or

electronic device. Must be able to occasionally stand and walk, climb stairs, and lift

equipment up to 25 pounds.

Firstsource is an Equal Employment Opportunity employer. All employment decisions are

based on valid job requirements, without regard to race, color, religion, sex (including

pregnancy, gender identity and sexual orientation), national origin, age, disability, genetic

information, veteran status, or any other characteristic protected under federal, state or local

law.

Firstsource also takes Affirmative Action to ensure that minority group individuals, females,

protected veterans, and qualified disabled persons are introduced into our workforce and

considered for employment and advancement opportunities