A Claims Examiner evaluates insurance claims in accordance with applicable contracts and government regulations within their insurance type. Determines member eligibility and financial responsibility of the insurance company.
On-Site / Local Office (In-Person Interview Required) About the Role Are you an analytical, detail-oriented insurance professional looking to take the next step in your career? We are seeking a dedicated Claims Examiner to join our operational team. In this role, you will evaluate insurance coverage, audit claims files, investigate discrepancies, and deliver top-tier service to policyholders and professional partners. This position offers a structured, full-time schedule in a fast-paced environment with a strong opportunity for long-term permanent employment for high-performing candidates.
Carefully review insurance policy terms, exclusions, and conditions to verify coverage eligibility and determine accurate benefit limits.
Claims Adjudication:
Process incoming claim documentation, medical bills, and proof-of-loss records to calculate payout amounts or draft clear, compliant denial letters.
File Auditing & Investigation:
Audit open and closed claim files for regulatory accuracy, investigate billing discrepancies, and ensure all file notes are audit-ready.
Stakeholder Communication:
Maintain clear, professional communication with claimants, service providers, and internal teams regarding claim status and decisions.
SLA & Compliance Tracking:
Consistently meet or exceed daily turnaround time metrics while adhering strictly to compliance guidelines and operational procedures. Requirements & Qualifications 2+ years of experience in insurance claims processing, adjudication, or account auditing. strong background in policy interpretation, coverage analysis, and document verification. Proficiency with CRM software, claims databases, and Microsoft Office Suite (Excel, Word, Outlook). Exceptional attention to detail, organization, and problem-solving skills. Ability to strictly adhere to the set schedule (M-F, 8:30 AM•5:00 PM). Must complete an in-person interview and a 1-week setup/onboarding window prior to start date.
salary:
$22•$23 per hour shift: First work hours: 8 AM•4 PM education:
Review complex insurance policy terms, conditions, and coverage details to determine claim eligibility, benefit limits, and applicable exclusions across primary and secondary coverages.
Claims Adjudication & Processing:
Evaluate incoming claims documentation, medical records, proof-of-loss filings, and receipts to accurately calculate benefit payouts or issue formal coverage denial notifications in compliance with company standards.
Discrepancy Investigation & File Auditing:
Investigate inconsistent claim details, audit file records for mathematical and regulatory accuracy, and identify potential fraud or billing discrepancies to recommend necessary corrective actions.
Stakeholder Communication:
Serve as the primary contact for claimants, healthcare providers, and internal teams, delivering professional status updates, explaining complex policy decisions, and resolving high-level customer disputes.
Compliance & SLA Adherence:
Maintain detailed, audit-ready documentation within CRM and claims databases while consistently meeting strict turnaround time metrics (SLAs) and adhering to the fixed schedule (Mon-Fri, 8:30 AM-5:00 PM).
Workflow Optimization:
Identify process bottlenecks, recommend efficiency improvements, and assist with training or onboarding team members on best practices, quality benchmarks, and operational procedures. Skills Claims Qualifications Years of experience: 3 years Experience level: Experienced Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.
Equal Opportunity Employer:
Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status. At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com. Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility). This posting is open for thirty (30) days.
