Health Claims Adjudicator

The Health Claims Adjudicator ensures prompt and accurate claims settlement, support for claims administration and to provide efficient and effective back office support to customer service for satisfaction of both internal and external clients on a timely basis

Health Claims Adjudicator

Health Claims Operations

Guardian Life of the Caribbean Limited

Job Objective:

The Health Claims Adjudicator ensures prompt and accurate claims settlement, support for claims administration and to provide efficient and effective back office support to customer service for satisfaction of both internal and external clients on a timely basis

Job Responsibilities:

• Processing of Local, Regional and Overseas claims within the authorized limits on the company’s health claims processing database and in accordance with company and performance standards. This is inclusive of the determination of the client’s eligibility for coordination; reviewing of the claim forms in detail to ensure that all provided information is complete and accurate.                           
• Processing of Pre-Certification requests from Provider and Clients.
• Identify process improvements and offer solutions to claim denials, resubmissions and other related processes.
• Support Customer Service Representatives/Claims Support Staff by assisting with simple queries and other customer concerns.     
• To perform any other job related duties as assigned by the Team Leader/ Manager.

Education:

• 5 CXC/CSEC Passes including Mathematics and English Language.
• 2 A’ Level/ CAPE passes
• LOMA 280, 290, ACS 100 and all related parts.
• Pursuing the ALHC Designation   

Experience:

• 2 years’ experience in Health Insurance Administration

Personality:

The Health Claims Adjudicator must be detailed oriented. He/ She must have the ability to establish and maintain good relations with customers. The incumbent must possess excellent communication and organizational skills and must be flexible.