Firstsource
Claims Examiner
United States · Full-time · Posted Oct 14, 2026
- Experience
- FEP Health claims processing experience is a must; no number of years stated.
- Education
- High School diploma or GED
About the job
Examines health insurance claims, determines coverage and liability, recommends claim outcomes, and communicates with claimants and stakeholders.
What you'll do
- Review claims and supporting documentation for validity, completeness, and policy compliance; investigate when needed.
- Determine coverage, liability, benefits, and settlement amounts, and recommend approval, denial, or negotiation.
- Maintain claim records, communicate status and information needs, and report on processing status and trends.
What they ask for
- FEP Health claims processing experience is a must.
- Strong analytical and problem-solving skills.
- Excellent communication and interpersonal skills.
- Proficiency with claims processing software and related tools.
Nice to have
- Knowledge of medical terminology, ICD-9/ICS-10, CPT, HCPCS coding, or HIPAA regulations.
- PC applications and systems, intermediate typing, and experience using multiple computer applications.
Tools
ICD-9/ICS-10, CPT, HCPCS, PC applications and systems, claims processing software
Model-written summary · the original posting is authoritative