Claims Processor

Job Summary:

We are seeking a detail-oriented and organized Claim Processor Specialist to reviews, verifies, and processes insurance claims to determine coverage eligibility, ensuring compliance with company and regulatory guidelines. You will act as the primary liaison between policyholders, insurance agents, and providers to gather information, calculate payments, and manage documentation to ensure prompt resolution.

Responsibilities:

• Review and process insurance claims accurately and promptly.
• Verify and analyze documentation to ensure completeness and eligibility under policy terms.
• Communicate with claimants, agents, and other stakeholders virtually to request additional information or clarify details.
• Evaluate claim validity and recommend approval, denial, or escalation.
• Maintain detailed electronic records of claim processing activities and decisions.
• Identify and flag potential fraud or inconsistencies for further review.
• Collaborate with internal teams remotely to resolve complex claims or issues.
• Ensure adherence to company policies, industry regulations, and service standards.
• Generate reports and summaries to track claim volumes, trends, and outcomes.

Requirements:

• Bachelor’s degree in Business, Finance, Insurance, or related field.
• 3-5 years of previous experience in claims processing and insurance.
• Strong understanding of insurance policies, regulations, and claims procedures.
• Excellent analytical, problem-solving, and decision-making skills.
• Knowledge working for U.S. A or U.K client.
• Close attention to detail and accuracy.
• Strong written and verbal communication skills suitable for remote work.
• Proficiency with claims management software and Microsoft Office Suite.
• Self-motivated with the ability to manage time and tasks effectively in a remote environment.
• Applicants must have a stable high-speed internet connection, a working laptop, and a reliable backup power source to maintain consistent work performance and communication.