Claims Examiner

The Claims Examiner position is responsible for evaluating and processing claims by performing all functions required to determine whether a claim is payable, deferred, or declined. This position ensures claims are handled in accordance with policy provisions, regulatory requirements, and company guidelines, while providing timely and professional correspondence to internal and external customers.

In the Role Evaluate claims against eligibility requirements, provisions and applicable processes Enter and maintain accurate data in claims processing systems, including written correspondence Research and gather additional information to support claim decisions Perform benefit calculations and conduct claim investigations Communicate with internal and external customers via phone and written correspondence Maintain positive customer relationships through professional and empathetic interactions Participate in departmental meetings, training activities, and continuous improvement initiatives Support occasional special projects and other duties as assigned Requirements High School diploma or equivalent required Minimum 2+ year of general work experience Strong analytical and problem-solving skills with attention to detail Ability to evaluate claims against eligibility requirements and interpret policy language Effective verbal and written communication skills Basic math skills and proficiency in a PC environment, including Microsoft Office Ability to build and maintain positive customer relationships One.

Main Holdings, Inc. is an Equal Employment Opportunity (EEO) employer. Qualified applicants will receive consideration for employment without regard to age, ancestry, citizenship status, color, creed, culture, disability, ethnicity, gender, gender identity or expression, genetic information or history, marital status, military status, national origin, nationality, pregnancy, race, religion, sex, sexual orientation, socioeconomic status, transgender or on any other basis protected by law.