Consultant -Claims Adjudicator

Are you detail-oriented, analytical, and passionate about delivering fair and accurate outcomes? We’re looking for a dedicated Consultant – Claims Adjudicator to join our dynamic team!About Guardian Life Of The Caribbean LimitedGuardian Life of the Caribbean Limited leads the charge in Life, Health, and Pension solutions throughout the Caribbean Region. Our unwavering mission is to cultivate financial freedom for our stakeholders through transformative interactions, fuelled by the relentless power of technology. With innovation at our core, we strive to redefine the landscape of financial services, empowering individuals, and businesses alike to pursue their dreams with confidence and security.

Job OverviewThe Consultant - 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 basisJob 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 & Experience 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 2 years’ experience in Health Insurance Administration.

Additional RequirementAs a regulated entity with obligations under the Know Your Employee guidelines, a Certificate of Character is required. Person SpecificationThe Consultant - 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. Applications will be treated with the utmost confidentiality.