Relation Insurance Services · 1 day ago
Claims Examiner
United States
Full-time
Remote
Entry Level
1+ years expRelation Insurance Services is seeking a Claims Examiner who will be responsible for verifying, adjudicating, and resolving insurance claims. The role involves ensuring claims are processed accurately and in compliance with company policies and regulations while maintaining effective communication with various stakeholders.
ConsultingEmployee BenefitsFinancial ServicesInsuranceRetirement
Responsibilities
Reviews and validates claims for accuracy, completeness, and eligibility based on policy terms and guidelines
Analyzes, adjudicates, and resolves claims by approving or denying documentation, calculating benefit amounts, and initiating payments or composing denial letters
Ensures legal compliance with company policies, procedures, and applicable state and federal regulations throughout the claims process
Maintains accurate records of claims, settlements, denials, and related documentation
Addresses questions and concerns from providers, clients, and internal personnel regarding the adjudication process
Reports overpayments, underpayments, and irregularities to supervisors
Communicates with reinsurance brokers and other stakeholders to obtain necessary information for claim processing
Verifies member eligibility, benefit coverage, and authorizations as needed
Protects confidential information and ensure HIPAA compliance
Participates in process improvement initiatives and update documentation as required
Special projects and other duties as assigned
Qualification
Required
High school diploma or equivalent required
Ability to read, analyze, and interpret company guidelines, benefit documentation, and government regulations
Intermediate computer skills, including email, database activity, word processing, and spreadsheets
Ability to handle multiple tasks simultaneously and adapt to changing priorities
Strong analytical, problem-solving, and communication skills
Preferred
Associate's degree or technical college coursework preferred
1–3 years of healthcare reimbursement, claims processing, or customer service experience preferred
In-depth knowledge of medical coding principles is helpful
Familiarity with Medicaid, Medicare, and commercial insurance claims preferred
Experience in provider contract development, medical billing/coding, patient accounting, claims auditing, or revenue cycle improvement
Benefits
Family health and wellness programs
401K
Employee assistance programs
Paid time off
Paid holidays
Company
Relation Insurance Services
Despite our size, Relation feels like a family company. Here, a handshake matters.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2019-02-21Acquired
Leadership Team
Charissa Hartmann
Chief Financial Officer
Brandon Youngfountain
Executive Vice President, Mergers & Acquisitions
Recent News
Mergers & Acquisitions
2025-11-11
2025-08-29
2025-08-26
Company data provided by crunchbase