A&H Claims Adjuster

Job DescriptionRole PurposeThe Accident and Health Claims Adjuster is responsiblefor the review, assessment, and management of A&H claims in a timely, fair, and accurate manner, ensuring compliance with policy terms, regulatory requirements and customer service standards..Key Responsibilities Review and analyze A&H claims to determine coverage and eligibility under policy terms. Communicate with policyholders, brokers, healthcare providers, and internal stakeholders to obtain necessary information and provide claim updates. Make timely decisions on claim approval, partial payment, or denial with clear justifications. Identify potential fraudulent claims and refer cases as necessary for investigation. Requirements QUALIFICATIONS Bachelor’s Degree in Business Administration. Adjusters License from the Office of the Commissioner of Insurance of Puerto Rico (OCS). Demonstrated experience and/or knowledge in claims related to the following coverage’s: Accident, Medical Expenses, Cancer, Critical Illnesses, Disability, Hospitalization, and SINOT, among others including policy interpretation. High attention to detail and accuracy. Ability to manage multiple claims and meet deadlines. Demonstrate flexibility and adaptability to work in a fast moving and challenging environment. Proficient in MS Applications (Word, Excel and Power Point). Intermediate knowledge of the structure and content of the English and Spanish Language. Experience Three (3) years of experience managing all major aspects of A&H claims adjustment process in the insurance industry, preferable. About UsChubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.