Job Summary: To effectively evaluate and adjudicate health claims accurately based on the proper interpretation of theunderlying contract and utilization of the company's mandated policy guidelines and code of conduct. Job Summary: Maintain established claims productivity levels. Provide back-up support to Claims Supervisor and ManagerAssist with preparation of financial and operational reports. Assist with any other functions assigned by management. Provide input and feedback to management for continuous process improvement.
Processes simple/moderate claims based on medical benefits, system data, case histories, plan documents, Claims Procedure Manual, MAG Mutual Physicians Fee & Coding Guide and Medical Association of the Bahamas guidelines. Knowledge & Skills: 5 BGCSE's (with grades C and above including Math & English)Associate degreeCertified Professional Coding certification with current accreditation preferred. Minimum 2 years' experience or equivalent knowledgeStrong knowledge of Microsoft Office Suite (Word, Excel, Outlook, PowerPoint)Well-developed written skills Demonstrated strong customer service experience. Effective time management skillsStrong organizational skills
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