Claims Examiner

Schenectady, NY

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Westaff is seeking Claims Examiners for their client in Schenectady!

This is a great contract opportunity to work with large health insurance company in the Capital District!


Schedule:  Monday-Friday 8:00 AM-4:30 PM

Rate of Pay:  $14.00/hour

Job Duties:

  • Adjudicates claims with the aid of the Facets and Macess Systems
  • Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible
  • Reviews and ensures the accuracy of all changes to claim line information based on information received from other departments and in accord with available benefit information
  • Responsible for the timely and accurate adjudication of claims that are suspended to other departments for benefit and/or authorization determination
  • Meets or exceeds department quality and work management standards for claims adjudication
  • Successfully completes a course of comprehensive formal training in all areas of benefits determination, system navigation, and policy
  • Suspends, investigates and resolves claim issues by coordinating with appropriate departments, based on criteria set by those departments
  • Handles inquiries regarding suspended claims from other departments and identifies trends in suspensions based on these inquiries and other feedback

Job Requirements

Job Requirements:

Minimum Education:

High school diploma or equivalent


Minimum Experience:

Previous health, dental or vision insurance experience required. Previous claims processing experience preferred.


Required Skills:

• Strong communication skills

• Organizational skills and attention to detail;

• Strong PC skills required, Microsoft Windows experience highly desired 


Call/Text 518-438-3010 to schedule your interview today!

Apply Now