Claims Examiner – Life, Accident, Critical Illness, LTC, and Hospital Indemnity

Location: Remote role based in Texas, United States; regular business hours are 9:00am–6:00pm Eastern. Occasional overtime or weekend work may be required during peak periods.

Hourly rate: $21.00

Company

hirify.global is the employer for this insurance claims role.

What you will do

• Evaluate incoming claims for eligibility, coverage, validity, liability, and payment authorization across accident, critical illness, short-term disability, long-term care, and hospital indemnity products.
• Investigate claims by reviewing medical records, policy provisions, contracts, and other supporting documentation.
• Communicate with policyholders, beneficiaries, healthcare providers, and other stakeholders about claim status and requirements.
• Document claim findings accurately in claims management systems and maintain complete records.
• Identify process improvements, participate in quality assurance initiatives, and collaborate on claims-handling best practices.
• Generate reports and analyze claims trends, processing times, and outcomes for management.

Requirements

• Bachelor’s degree in business administration, insurance, healthcare management, or a related field, or equivalent work experience.
• Prior experience in claims processing, preferably in accident, critical illness, long-term care, or hospital indemnity insurance.
• Knowledge of insurance principles, policies, practices, and regulatory requirements.
• Strong analytical, problem-solving, organizational, communication, and customer service skills.
• Proficiency with claims management software and Microsoft Office, including Excel, Word, and Outlook.
• Ability to work accurately and independently while collaborating in a fast-paced environment.

Nice to have

• ACS and/or ALHC designation.
• Experience with medical terminology and healthcare billing practices.

Culture & Benefits

• Remote work environment with regular Eastern Time business hours.
• Opportunities for professional development and career advancement within the claims department or broader insurance organization.
• Use of emerging AI tools, including copilots, chat-based AI, and automation solutions, to improve workflows and solve problems.
• Occasional overtime or weekend work during peak periods may be required.