Claims Adjudicator (Temporary)

The Claims Adjudicator is responsible for processing all medical reimbursement and provider claims, as well as any other claims within the medical line of business.

What We’re Looking For:

Key Knowledge, Skills and Abilities

• Clear written and verbal communication with both internal and external clients;
• Strong interpersonal skills and the ability to work individually and as part of a team.
• Must be detail oriented.
• Demonstrates solid judgement and discretion working with confidential information.
• Organized and able to work well in a fast-paced environment.
• Proper time management skills.

Minimum Training and Experience

• Five (5) CXC/GCE O’levels inclusive of English Language and Mathematics
• Minimum 2-3 years’ experience in the insurance industry
• Computer Literate in Microsoft Office Suite.
• Any equivalent combination of training and experience.

What You’ll be Responsible For:

• Process Medical, Accidental Death and Dismemberment, Critical Illness Claims, and any other related claims in accordance with the company’s established procedures, policy terms and conditions, and schedule of benefits and authorized limit outlined by the Regional Medical Claims Manager.
• Review all claims received in detail to ensure that all information provided is complete and accurate for processing/adjudication within 24 hours of receipt.
• Intimate/log all claims in the medical system within 24 hours of receipt for processing within the established claims turnaround time and/or the agreed service standards for the policyholders.
• Process/adjudicate a minimum of 60 medical claims daily, with 99% accuracy rate, and all relevant documents are uploaded and in the medical system as assigned by the Supervisor.
• Receive and accurately process all pre-certification requests from providers and policyholders within the established turnaround time.
• Determine the client's eligibility for coordination of benefits upon receipt.
• Generate and dispatch all Explanation of Benefits to policyholders electronically once medical claims are adjudicated and approved.
• Demonstrate sound judgement and discretion when working with confidential information and client privacy.
• Provide customer service to policyholders on claims-related matters, ensuring that all queries and concerns are addressed promptly and courteouslty within the scope of coverage, taking initative and demonstrating a high level of professionalism, in accordance with established service standards.
• File and upload all documents used electronically within the claims function on the applicable SharePoint site, where applicable.
• Demonstrate a thorough knowledge of the Company’s products and procedures, and a good understanding of industry regulations pertinent to the provision of information and services to clients.
• To perform any other job-related duties as assigned by Management.

Take the next step in your career with NAGICO Insurances where your expertise makes a difference!