SENIOR CLAIMS EXAMINER
Senior Claims Examiner is a local-government title in New Jersey's competitive civil service, which means the way in is an open exam rather than a direct appointment.
The main requirement is 3 years of relevant experience.
How to apply
This title is filled by competitive examination.
See every real route in, and where to apply. We don't track live vacancies.
See where to apply for this title →Where this title is used
Senior Claims Examiner is a local service title. It is filled by the counties, municipalities, authorities and other employers that have adopted civil service under Title 11A, not by State departments. Those employers set pay by ordinance or contract rather than from a State salary schedule, which is why most local titles carry no salary range here.
Check whether an employer is a civil service jurisdiction · How local civil service works
Official job specification
The text below is the official specification published by the New Jersey Civil Service Commission. The plain-language summary and analysis above are derived from it by NJ Civil Service Navigator. Source: the official specification page at NJ CSC.
Definition
Under direction, performs the work involved in insurance plan enrollments, processes and verifies claims, issues payments; may take the lead in a claims unit; does related work as required.
Examples of work
- Processes enrollments, adjustments, terminations and additions to insurance policies.
- Interviews employees and others to obtain information.
- Processes claims.
- Verifies the validity of claims; computes claim amounts.
- Contacts hospitals, pharmacies and physicians for claim information.
- Determines whether additional compensation is warranted.
- Issues drafts for payment of valid claims.
- Explains claim disapproval's.
- Maintains records and files.
- Will be required to learn to utilize various types of electronic and/or manual recording and information systems used by the agency, office or related units.
Experience
Three (3) years of experience processing and verifying claims, computing numerical values and obtaining information needed for claim processing.
License
Appointees will be required to possess a driver's license valid in New Jersey only if the operation of a vehicle, rather than employee mobility, is necessary to perform essential duties of the position.
Knowledge, skills and abilities
- Knowledge of office methods, practices, and equipment.
- Knowledge of the methods used to compute numerical values.
- Knowledge of the methods used to process and verify claims.
- Knowledge of the methods used to collect data.
- Ability to add, multiply, and divide fractions and whole numbers.
- Ability to verify and process claims.
- Ability to interpret laws, rules and regulations and apply them to specific situations.
- Ability to collect data through questioning.
- Ability to explain claim disapprovals.
- Ability to maintain records and files.
- Ability to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units.
- Ability to read, write, speak, understand, and communicate in English sufficiently to perform duties of this position. American Sign Language or Braille may also be considered as acceptable forms of communication.
- Persons with mental or physical disabilities are eligible as long as they can perform essential functions of the job after reasonable accommodation is made to their known limitations. If the accommodation cannot be made because it would cause the employer undue hardship, such persons may not be eligible.
Note
The examples of work for this title are for illustrative purposes only. A particular position using this title may not perform all duties listed in this job specification. Conversely, all duties performed on the job may not be listed.