Health Claims Adjudicator

Are you detail-oriented, analytical, and passionate about improving healthcare? As a Health Claims Adjudicator, you’ll ensure each claim is processed with accuracy, fairness, and care — helping people access the services they need. If you’re a problem-solver who thrives on precision and purpose, this is your opportunity to make a real impact.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 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 CLAIMS PROCESSING 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. PRECERTIFICATION/ESTIMATES PROCESSING Accurate and Efficient Processing or review of Pre-Certification requests from Provider and Clients. QUERY MANAGEMENT Support Customer Service Representatives/Claims Support Staff by assisting with simple queries and other customer concerns. PROCESS IMPROVEMENT Identifying process improvements and offer solutions to claim denials, resubmissions and other related processes. To perform any other job-related duties as assigned by the Team Leader/ Manager.Education And Experience 5 CXC/ CSEC passes including Mathematics and English Language. 2 A’ Level/ CAPE passes LOMA 281, 291, ACS 101 and all related parts. Pursuing the ALHC Designation At least 2 years work experience in a Health Claims environment adjudicating claimsAdditional RequirementAs a regulated entity with obligations under the Know Your Employee guidelines, a Certificate of Character is required.Person SpecificationThe 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. He/ She must be a very meticulous, organised and detail-oriented individual. The individual must possess strong problem-solving skills and be able to make sound decisions.Applications will be treated with the utmost confidentiality.