Claims Examiner / Customer Benefits Payment Representative

Claims Examiner / Customer Benefits Payment Representative

Location: St. Paul, MN
Work Arrangement: Hybrid – 1 mandatory day onsite in St. Paul, 4 days remote
Schedule: Monday-Friday | 8:00 AM-4:45 PM | 45-minute unpaid lunch
Employment Type: Contract
Compensation: $28-$32/hour, depending on experience

Position Overview

Beacon Hill’s client is seeking a detail-oriented Claims Examiner / Customer Benefits Payment Representative to support the accurate and timely review, processing, and payment of customer benefit claims. This position is ideal for someone with claims adjudication experience who combines strong analytical skills with a customer-focused mindset.

The role will focus heavily on reviewing claim files for accuracy and completeness, identifying potential errors or process gaps, completing corrective actions, and ensuring claims are handled consistently with applicable policy provisions and service expectations.

Responsibilities

• Perform quality reviews and audits of Accident, Critical Illness, and Hospital Indemnity claims to confirm accurate processing and consistent application of policy provisions.
• Examine claim files to ensure required documentation has been collected, eligibility criteria have been satisfied, appropriate benefits have been identified, and payments have been processed correctly.
• Recognize claim-processing errors, recurring trends, workflow gaps, and opportunities to strengthen operational processes.
• Clearly document audit results and communicate findings, recommendations, and necessary corrective measures to appropriate partners.
• Make corrections to claim files when needed, including gathering additional information, revising claim determinations, issuing benefits, and resolving payment discrepancies.
• Support timely and accurate benefit payments through claim processing, data entry, record maintenance, fraud prevention, and eligibility or loss investigations.
• Provide professional, customer-focused communication to internal teams, clients, customers, and external partners.
• Maintain complete and accurate claim documentation to support quality standards, regulatory requirements, customer service, and potential litigation needs.
• Apply sound judgment and risk assessment when reviewing claims and determining appropriate next steps.
• Use available resources and strong problem-solving skills to investigate claims and reach well-supported conclusions.
• Review files for completeness and verify that all required information and supporting documentation are accurate.
• Contribute to special projects, process enhancements, quality initiatives, and other operational improvement efforts.
• Effectively manage an assigned workload while meeting established service levels and turnaround expectations.
• Assist with incoming department calls and respond to questions regarding claim status, policy provisions, and benefit determinations.

Qualifications

• Previous knowledge of or experience with Employee Benefit Solutions claims processing and claim adjudication practices.
• Excellent attention to detail with the ability to identify discrepancies, errors, and areas for improvement.
• Strong analytical, critical-thinking, and problem-solving abilities.
• Sound judgment and confidence making decisions based on available claim information.
• Strong written and verbal communication skills.
• Effective organizational and workload-management abilities.
• Positive, compassionate, and customer-focused approach.
• Ability to successfully meet expectations while working independently as well as collaboratively within a team.
• Comfortable learning and adapting to new technologies, systems, and changing processes.
• Strong commitment to providing a high-quality customer experience.