Claims Examiner, Credit

Responsible for providing professional customer service to insureds and accounts while adjudicating credit protection and debt cancellation claims. Allocates time between claim adjudication and claims customer service, reviewing submitted information, coverage, and documentation in a timely manner.

Minimum Qualifications:

• High School Diploma or equivalent.

• 2 years’ experience in claims and/or other related claims processes.

• Customer Service training is imperative since we communicate verbally on the phone and in written correspondence.

• Fraud Awareness training and Claims Experience required.
• Insurance Certifications, designations or licenses preferred, not required.

Primary Job Functions:

• Enter and adjudicate claims by reviewing documentation and determining appropriate action (pay, pend, or deny) in accordance with policy provisions, exclusions, and eligibility criteria.
• Dynamically allocating time between claim adjudication and inbound customer service based on business needs, handling approximately 40–60 calls on designated call days.
• Ability to efficiently navigate and multitask across multiple screens and software platforms.
• Investigate claims with potential fraud indicators and escalate findings in alignment with anti-fraud protocols.
• Communicate with insureds, accounts, and vendors to obtain and validate required information.
• Maintain complete, audit-ready documentation to support legal, regulatory, and internal review requirements.
• Ensure adherence to state regulations, HIPAA privacy standards, and company compliance guidelines to support accurate and compliant claim handling.
• Provide cross-functional support as needed, serving as a backup resource to other departments across customer service, claim adjudication, and administrative functions to ensure continuity of operations and service levels.

The above cited duties and responsibilities describe the general nature and level of work performed by people assigned to the job. They are not intended to be an exhaustive list of all the duties and responsibilities that an incumbent may be expected or asked to perform.

Additional Information:

Full benefit package including medical, dental, life, vision, company paid short/long term disability, 401(k), tuition assistance and more

#LI-Onsite

Job Posting Disclaimer:

Fortegra has recently been made aware of unauthorized communications regarding career opportunities by individuals not associated with Fortegra or our recruitment team. Fortegra will only contact you from the Fortegra domain address (@fortegra.com). If you receive a message from someone posing as a Fortegra recruiter via text message, WhatsApp, Telegram or other messaging platform, please report it as phishing and block the sender.

Fortegra is not accepting unsolicited resumes from search firms for this position.

Please be aware of job fraud(s) – all correspondence emails regarding your candidacy will come from our Fortegra.com email address. Thank you.