Claims Advisor

The Claims Advisor is responsible for delivering professional and responsive customer service while reviewing and processing claims accurately and efficiently. This role evaluates submitted documentation, policy coverage, and eligibility information to adjudicate, pend, investigate, approve, adjust, or deny claims in accordance with contractual provisions, company guidelines, and regulatory requirements.

The Claims Advisor applies strong attention to detail and sound decision-making skills to ensure accurate claim outcomes, identify potentially fraudulent activity for leadership review, and maintain productivity and service standards in a fast-paced environment. This position may process various claim types.