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Claims Examiner

May 12, 2026

<span class="jobdescription"><div> <div> <p><span>Job Title: </span><span>Claims Examiner</span> - Remote</p> <p>Pay Rate: $14/hr</p> <p>Schedule: Monday-Friday 8.00am-4.30pm EST (possible overtime)</p> </div> <div> <p><span>Job Type:</span><span> </span><span>Full Time</span><span> </span></p> </div> <div> <p><span>FLSA Status:</span><span> Non-Exempt/Hourly</span><span> </span></p> </div> <div> <p><span>Grade:</span><span> H2</span><span> </span></p> </div> <div> <p><span>Function/Department: </span><span>Health Plan and Healthcare Services</span><span> </span></p> </div> <div> <p><span>Reporting to: </span><span>Team Lead/Supervisor - Operations</span><span> </span></p> </div> <div> <p><span>Role Description:</span><span> 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.</span><span> </span></p> </div> <div> <p><span>Key Responsibilities </span><span> </span></p> </div> <div> <ul style="list-style-type:disc"> <li> <p><span>Should have Excellent Analytical skills to review claims based on rules and workflows. </span><span> </span></p> </li> </ul> </div> <div> <ul style="list-style-type:disc"> <li> <p><span>Need good comprehension skills to adjudicate claims as per Policies and Procedures. </span><span> </span></p> </li> </ul> </div> <div> <ul style="list-style-type:disc"> <li> <p><span>Should be a complete team player </span><span> </span></p> </li> </ul> </div> <div> <p><span> </span></p> </div> <div> <p><span>Key Performance Indicators:</span><span> </span><span> </span></p> </div> </div> <div> <div> <p><span>• Ensuring that the key Service Level Agreements are met consistently without any exceptions. </span><span> </span></p> </div> <div> <p><span>• Achieve set Production goals. </span><span> </span></p> </div> <div> <p><span>• Adherence to departmental and company rules and regulations.</span><span> </span></p> </div> <div> <p><span>Qualifications</span><span> </span></p> </div> <div> <p><span>The 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.</span><span> </span></p> </div> <div> <p><span>Top of Form</span><span> </span></p> </div> <div> <p><span><span>Top of </span><span>Form</span></span><span><span>Education</span><span> </span></span><span> </span></p> </div> <div> <ul style="list-style-type:disc"> <li> <p><span>High School diploma or equivalent required</span> <span> </span></p> </li> </ul> </div> <div> <p><span>Competencies & Skills</span><span> </span></p> </div> <div> <ul style="list-style-type:disc"> <li> <p><span>Highly-motivated and success-driven </span><span> </span></p> </li> </ul> </div> <div> <ul style="list-style-type:disc"> <li> <p><span>Exceptional verbal and written communication and interpersonal skills, including negotiation and active-listening skills</span><span> </span></p> </li> </ul> </div> <div> <ul style="list-style-type:disc"> <li> <p><span>Exceptional analytical and problem-solving skills </span><span> </span></p> </li> </ul> </div> <div> <ul style="list-style-type:disc"> <li> <p><span>Strong attention to detail with a commitment to accuracy</span><span> </span></p> </li> </ul> </div> <div> <ul style="list-style-type:disc"> <li> <p><span>Ability to adapt to change in a dynamic fast-paced environment with fluctuating workloads</span><span> </span></p> </li> </ul> </div> <div> <ul style="list-style-type:disc"> <li> <p><span>Basic mathematical skills</span><span> </span></p> </li> </ul> </div> </div> <div> <div> <ul style="list-style-type:disc"> <li> <p><span>Intermediate typing skills</span><span> </span></p> </li> </ul> </div> <div> <ul style="list-style-type:disc"> <li> <p><span>Basic computer skills </span><span> </span></p> </li> </ul> </div> <div> <ul style="list-style-type:disc"> <li> <p><span>Knowledge of medical terminology, </span><span>ICD-9/ICS-10, CPT, and HCPCS coding, and HIPAA regulations preferred</span><span> </span></p> </li> </ul> </div> <div> <ul style="list-style-type:disc"> <li> <p><span>Knowledge of insurance policies, regulations, and best practices preferred</span><span> </span></p> </li> </ul> </div> <div> <p><span>Additional Qualifications</span><span> </span></p> </div> <div> <ul style="list-style-type:disc"> <li> <p><span>Ability to download 2-factor authentication application(s) on personal device, in accordance with company and/or client requirements</span><span> </span></p> </li> </ul> </div> <div> <ul style="list-style-type:disc"> <li> <p><span>Ability to pass the required pre-employment background investigation, including but not limited to, criminal history, work authorization verification and drug test</span><span> </span></p> </li> </ul> </div> <div> <p><span>Work Environment</span><span> </span></p> </div> <div> <p><span>The 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.</span><span> </span></p> </div> <div> <p><span>This position may work onsite or remotely from home.  </span><span> </span></p> </div> <div> <p><span>Physical Demands</span><span> </span></p> </div> <div> <p><span>The 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.</span> <span> </span></p> </div> <div> <p><span>Must 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.</span> <span> </span></p> </div> <div> <div> <p><span>About Firstsource </span><span> </span></p> </div> <div> <p><span>Firstsource 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. </span> <span>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. </span> <span>Our clientele includes Fortune 500 and FTSE 100 companies.</span> <span> </span></p> </div> </div> <div> <p><span>Firstsource 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.  </span> <span> </span></p> </div> </div> <div> <p><span>Firstsource 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.</span><span> </span></p> </div> </span>

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...