Claims Processor/Customer Service

ComTon, Inc.

Job Description

Claims Processor Customer Service:

  • Serves customers by determining insurance coverage;
  • examining and resolving claims issues;
  • documenting actions;
  • maintaining quality customer services;
  • ensuring legal compliance.


  • Determines covered benefits by studying provisions of policy or certificate.
  • Establishes proof by studying documentation;
  • assembling additional information as required from outside sources, including claimant, physician, employer, and other insurance companies
  • Process claims by approving or denying documentation;
  • calculating benefit due; initiating payment or composing denial letter.
  • Ensures compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.
  • Maintains quality customer services by following customer service practices; responding to customer inquiries.
  • Protects operations by keeping claims information confidential.
  • Prepares reports by collecting, analyzing, and summarizing information.
  • Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
  • Accomplishes organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.


  • Claims Experience
  • Documentation Skills
  • Data Entry Skills
  • Analyzing Information
  • Problem Solving
  • Verbal Communication
  • Customer Focus
  • General Math Skills
  • Proficient with Microsoft Office applications (Word Excel, Outlook, PowerPoint )

Contact Rob with resume.

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