The Health Claims Adjudicator II ensures prompt and accurate individual and provider claims settlement, support for the claim 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.
KEY DUTIES AND RESPONSIBILITIES
- Processes local claims within the authorized limits on the company health claims processing database and in accordance with company and performance standards;
- Determines the client’s eligibility for coordination;
- Reviews the claim forms in detail to ensure that all provided information is complete and accurate;
- Processes Pre-Certification requests from providers and clients;
- Identifies process improvements and offers solutions to claim denials, resubmissions and other related processes;
- Supports Customer Service Representatives/Claims Support Staff by assisting with simple queries and other customer concerns;
- Performs any other job-related duties as assigned by the Claims Supervisor and Operations Manager
KNOWLEDGE & EXPERIENCE
- 5 CXC/CSEC Passes including Mathematics and English language;
- 2 A Level/CAPE passes;
- Three years’ experience in Health Insurance Administration;
- LOMA 280, 290, ACS 100 and all related parts;
- Pursuing the ALHC designation;
- Excellent communication and organisational skills and must be flexible;
- Must be detailed-oriented;
- Must have the ability to establish and maintain good relations with customers;
- Team Oriented and have the initiative to seek Continuous improvement;
- Quality work ethic, excellent planning skills with knack of serving people;
- Motivated and disciplined;
- Organised and able to work well under pressure;
- Strong working knowledge in computer skills.
Compensation and Benefits:
The selected candidate will be offered an attractive salary which will be commensurate with experience and education.
Applications Close on February 28th, 2021.