{"schemaVersion":"jobsearcher.job.v1","id":"3547f6bdf190984c0dacd3dc","url":"https://jobsearcher.com/jobs/3547f6bdf190984c0dacd3dc","canonicalUrl":"https://jobsearcher.com/jobs/3547f6bdf190984c0dacd3dc","title":"Claims Examiner","description":"Job Title: Claims Examiner - Remote\r\nPay Rate: $14/hr\r\nSchedule: Monday-Friday 8.00am-4.30pm EST (possible overtime)\r\nJob Type: Full Time\r\nFLSA Status: Non-Exempt/Hourly\r\nGrade: H2\r\nFunction/Department: Health Plan and Healthcare Services\r\nReporting to: Team Lead/Supervisor - Operations\r\nRole Description: A claims examiner needs to analyse multiple documents / contracts and decide to pay / deny the claim submitted by member or providers with respect to client specifications. The claims examiner should also route the claim to different department or provider / member for any missing information that required for claims adjudication. The claims need to be completed adhering to required TAT and quality SLA.\r\nKey Responsibilities\r\n\r\n\r\nShould have Excellent Analytical skills to review claims based on rules and workflows.\r\n\r\n\r\nNeed good comprehension skills to adjudicate claims as per Policies and Procedures.\r\n\r\n\r\nShould be a complete team player\r\n\r\n\r\nKey Performance Indicators\r\n\r\nEnsuring that the key Service Level Agreements are met consistently without any exceptions.\r\nAchieve set Production goals.\r\nAdherence to departmental and company rules and regulations.\r\n\r\nQualifications\r\nThe qualifications listed below are representative of the background, knowledge, skill, and/or ability required to perform their duties and responsibilities satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.\r\nTop of Form\r\nTop of FormEducation\r\n\r\nHigh School diploma or equivalent required\r\n\r\nCompetencies & Skills\r\n\r\n\r\nHighly-motivated and success-driven\r\n\r\n\r\nExceptional verbal and written communication and interpersonal skills, including negotiation and active-listening skills\r\n\r\n\r\nExceptional analytical and problem-solving skills\r\n\r\n\r\nStrong attention to detail with a commitment to accuracy\r\n\r\n\r\nAbility to adapt to change in a dynamic fast-paced environment with fluctuating workloads\r\n\r\n\r\nBasic mathematical skills\r\n\r\n\r\nIntermediate typing skills\r\n\r\n\r\nBasic computer skills\r\n\r\n\r\nKnowledge of medical terminology, ICD-9/ICS-10, CPT, and HCPCS coding, and HIPAA regulations preferred\r\n\r\n\r\nKnowledge of insurance policies, regulations, and best practices preferred\r\n\r\n\r\nAdditional Qualifications\r\n\r\n\r\nAbility to download 2-factor authentication application(s) on personal device, in accordance with company and/or client requirements\r\n\r\n\r\nAbility to pass the required pre-employment background investigation, including but not limited to, criminal history, work authorization verification and drug test\r\n\r\n\r\nWork Environment\r\nThe work environment characteristics described here are representative of those an employee encounters while performing this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.\r\nThis position may work onsite or remotely from home.\r\nPhysical Demands\r\nThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.\r\nMust be able to regularly or frequently talk and hear, sit for prolonged periods, use hands and fingers to type, and use close vision to view and read from a computer screen and/or electronic device.  Must be able to occasionally stand and walk, climb stairs, and lift equipment up to 25 pounds.\r\nAbout Firstsource\r\nFirstsource Solutions is a leading provider of customized Business Process Management (BPM) services. Firstsource specialises in helping customers stay ahead of the curve through transformational solutions to reimagine business processes and deliver increased efficiency, deeper insights, and superior outcomes. We are trusted brand custodians and long-term partners to 100+ leading brands with presence in the US, UK, Philippines, India and Mexico. Our 'rightshore' delivery model offers solutions covering complete customer lifecycle across Healthcare, Telecommunications & Media and Banking, Financial Services & Insurance verticals. Our clientele includes Fortune 500 and FTSE 100 companies.\r\nFirstsource is an Equal Employment Opportunity employer.  All employment decisions are based on valid job requirements, without regard to race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, age, disability, genetic information, veteran status, or any other characteristic protected under federal, state or local law.\r\nFirstsource also takes Affirmative Action to ensure that minority group individuals, females, protected veterans, and qualified disabled persons are introduced into our workforce and considered for employment and advancement opportunities.","company":"Firstsource Solutions","rawCompany":"firstsource solutions","city":"Remote","state":"OR","isRemote":false,"isActive":false,"createdAt":"2026-05-10T05:23:49.618Z","occupations":[{"code":"13-1031.00","title":"Claims Adjusters, Examiners, and Investigators","slug":"claims-adjusters-examiners-and-investigators"},{"code":"43-9041.00","title":"Insurance Claims and Policy Processing Clerks","slug":"insurance-claims-and-policy-processing-clerks"},{"code":"29-9021.00","title":"Health Information Technologists and Medical Registrars","slug":"health-information-technologists-and-medical-registrars"}],"industries":[{"code":"524298","title":"All Other Insurance Related Activities","slug":"all-other-insurance-related-activities"},{"code":"524292","title":"Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds","slug":"pharmacy-benefit-management-and-other-third-party-administration-of-insurance-and-pension-funds"},{"code":"524291","title":"Claims Adjusting","slug":"claims-adjusting"}],"jobPosting":{"@context":"https://schema.org","@type":"JobPosting","title":"Claims Examiner","description":"Job Title: Claims Examiner - Remote\r\nPay Rate: $14/hr\r\nSchedule: Monday-Friday 8.00am-4.30pm EST (possible overtime)\r\nJob Type: Full Time\r\nFLSA Status: Non-Exempt/Hourly\r\nGrade: H2\r\nFunction/Department: Health Plan and Healthcare Services\r\nReporting to: Team Lead/Supervisor - Operations\r\nRole Description: A claims examiner needs to analyse multiple documents / contracts and decide to pay / deny the claim submitted by member or providers with respect to client specifications. The claims examiner should also route the claim to different department or provider / member for any missing information that required for claims adjudication. The claims need to be completed adhering to required TAT and quality SLA.\r\nKey Responsibilities\r\n\r\n\r\nShould have Excellent Analytical skills to review claims based on rules and workflows.\r\n\r\n\r\nNeed good comprehension skills to adjudicate claims as per Policies and Procedures.\r\n\r\n\r\nShould be a complete team player\r\n\r\n\r\nKey Performance Indicators\r\n\r\nEnsuring that the key Service Level Agreements are met consistently without any exceptions.\r\nAchieve set Production goals.\r\nAdherence to departmental and company rules and regulations.\r\n\r\nQualifications\r\nThe qualifications listed below are representative of the background, knowledge, skill, and/or ability required to perform their duties and responsibilities satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.\r\nTop of Form\r\nTop of FormEducation\r\n\r\nHigh School diploma or equivalent required\r\n\r\nCompetencies & Skills\r\n\r\n\r\nHighly-motivated and success-driven\r\n\r\n\r\nExceptional verbal and written communication and interpersonal skills, including negotiation and active-listening skills\r\n\r\n\r\nExceptional analytical and problem-solving skills\r\n\r\n\r\nStrong attention to detail with a commitment to accuracy\r\n\r\n\r\nAbility to adapt to change in a dynamic fast-paced environment with fluctuating workloads\r\n\r\n\r\nBasic mathematical skills\r\n\r\n\r\nIntermediate typing skills\r\n\r\n\r\nBasic computer skills\r\n\r\n\r\nKnowledge of medical terminology, ICD-9/ICS-10, CPT, and HCPCS coding, and HIPAA regulations preferred\r\n\r\n\r\nKnowledge of insurance policies, regulations, and best practices preferred\r\n\r\n\r\nAdditional Qualifications\r\n\r\n\r\nAbility to download 2-factor authentication application(s) on personal device, in accordance with company and/or client requirements\r\n\r\n\r\nAbility to pass the required pre-employment background investigation, including but not limited to, criminal history, work authorization verification and drug test\r\n\r\n\r\nWork Environment\r\nThe work environment characteristics described here are representative of those an employee encounters while performing this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.\r\nThis position may work onsite or remotely from home.\r\nPhysical Demands\r\nThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.\r\nMust be able to regularly or frequently talk and hear, sit for prolonged periods, use hands and fingers to type, and use close vision to view and read from a computer screen and/or electronic device.  Must be able to occasionally stand and walk, climb stairs, and lift equipment up to 25 pounds.\r\nAbout Firstsource\r\nFirstsource Solutions is a leading provider of customized Business Process Management (BPM) services. Firstsource specialises in helping customers stay ahead of the curve through transformational solutions to reimagine business processes and deliver increased efficiency, deeper insights, and superior outcomes. We are trusted brand custodians and long-term partners to 100+ leading brands with presence in the US, UK, Philippines, India and Mexico. Our 'rightshore' delivery model offers solutions covering complete customer lifecycle across Healthcare, Telecommunications & Media and Banking, Financial Services & Insurance verticals. Our clientele includes Fortune 500 and FTSE 100 companies.\r\nFirstsource is an Equal Employment Opportunity employer.  All employment decisions are based on valid job requirements, without regard to race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, age, disability, genetic information, veteran status, or any other characteristic protected under federal, state or local law.\r\nFirstsource also takes Affirmative Action to ensure that minority group individuals, females, protected veterans, and qualified disabled persons are introduced into our workforce and considered for employment and advancement opportunities.","datePosted":"2026-05-10T05:23:49.618Z","dateModified":"2026-05-10T05:23:49.618Z","hiringOrganization":{"@type":"Organization","name":"Firstsource Solutions","sameAs":"https://jobsearcher.com"},"jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Remote","addressRegion":"OR","addressCountry":"US"}},"identifier":{"@type":"PropertyValue","name":"JobSearcher","value":"3547f6bdf190984c0dacd3dc"},"url":"https://jobsearcher.com/jobs/3547f6bdf190984c0dacd3dc"}}