Claims Examiner (Insurance)

TL;DR

Claims Examiner (Insurance): Assessing and processing insurance claims for accident, critical illness, and hospital indemnity products with an accent on policy verification, liability determination, and regulatory compliance. Focus on investigating complex claims, maintaining accurate documentation, and leveraging AI tools to optimize workflows and improve processing efficiency.

Location: Must be based in the United States (Remote, Eastern Time zone alignment required).

Company

hirify.global is a software corporation providing specialized solutions for various industries, including insurance and healthcare.

What you will do

• Evaluate incoming claims to determine eligibility, coverage, and validity.
• Conduct thorough investigations by reviewing medical records and policy provisions.
• Communicate professionally with policyholders, beneficiaries, and healthcare providers.
• Document findings and process claims efficiently within management systems.
• Generate reports and analyze claims trends to support operational improvements.
• Actively adopt and leverage AI-enabled tools to solve problems and drive efficiency.

Requirements

• Bachelor's degree in business, insurance, or healthcare management (or equivalent experience).
• Prior experience in claims processing, specifically in accident, critical illness, or hospital indemnity insurance.
• Strong analytical and problem-solving skills with the ability to interpret complex policies.
• Proficiency in claims management software and Microsoft Office Suite.
• Must be based in the United States and available during 9:00am – 6:00pm Eastern time.
• Willingness to actively adopt and leverage emerging AI tools in daily workflows.

Nice to have

• ACS and/or ALHC Designation.
• Experience with medical terminology and healthcare billing practices.
• Understanding of insurance industry regulatory requirements.

Culture & Benefits

• Remote work environment with regular business hours.
• Opportunities for professional development and career advancement.
• Exposure to modern AI-driven automation solutions in the insurance sector.
• Collaborative team environment with a focus on service standards and quality assurance.