Medical Claims Specialist Examiner Job Responsibilities: Serves medical insurance customers by determining insurance coverage; examining and resolving medical claims; documenting actions; maintaining quality customer services; ensuring legal compliance. Medical Claims Specialist Examiner Job Duties: Documents medical claims actions by completing forms, reports, logs, and records. Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter. Ensures legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.