Claims Examiner I

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Claims Examiner I examines and adjudicates insurance claims to determine coverage, validity, and appropriate payment in accordance with policy terms and regulations. Reviews claim documentation, policy provisions, and supporting evidence to assess liability and exposure. Being a Claims Examiner I authorizes claim payments within established authority limits. Investigates questionable or complex claims and coordinates with adjusters, providers, or external parties as needed. Additionally, Claims Examiner I documents findings, decisions, and rationale clearly within the claims system. Ensures compliance with company guidelines, regulatory requirements, and service standards. Requires a bachelor's degree. Typically reports to a manager. The Claims Examiner I work is closely managed. Works on projects/matters of limited complexity in a support role. To be a Claims Examiner I typically requires 0-2 years of related experience.