Health Claims Manager

Cayman Islands National Insurance Company; George Town; Vor Ort; MYR 368.000 - 614.000; Vollzeit

Zusammenfassung

The Cayman Islands National Insurance Company (CINICO) invites applications for a senior Claims Operations position reporting to the Chief Operating Officer. The post holder will actively manage the claims department, ensuring accuracy, quality and regulatory compliance in settlement of health insurance claims.

Responsibilities include leading a team of claims professionals, coordinating with overseas TPAs and providers, reporting metrics, and participating in policy development.

Qualifikationen

• Bachelor’s degree required or equivalent in a related field.
• 7+ years of health insurance industry experience, preferably in claims.
• Strong communication, organization and multitasking skills.

Aufgaben

• Oversee day-to-day claims operations, including processing, adjudication and customer service, to meet quality and production standards.
• Lead a team of Claims Adjudicators and Claims Administrators, with regular performance evaluations.
• Collaborate with overseas TPAs and providers to ensure high-quality claims processing.
• Report metrics and assist senior management with policy development and rollout.
• Ensure compliance with policies, procedures and regulatory requirements; maintain confidentiality of information.
• Represent CINICO on boards, committees or governance panels as required.
• Willing to undertake travel and staff training as needed by the COO and senior management.

Kenntnisse

Claims adjudication

Staff management

Quality assurance

Regulatory compliance

Provider networks

Data reporting

Customer service

Communication

Ausbildung

Bachelor's degree in a related area

Certifications: ICA, CII, IIA, LOMA or ICD9/10 & CPT Coding (advantage)

Tools

Microsoft Outlook

Excel

Word

Jobbeschreibung

About Us

Cayman Islands National Insurance Company (CINICO) is a government-owned company formed to provide health insurance coverage to civil servants (employees and pensioners) and other residents of the Cayman Islands and has expanded to provide a greater choice of health insurance plans and property & casualty products for residents of the Cayman Islands. The post holder will be responsible for the adjudication of health insurance claims from healthcare providers and covered members.

The Cayman Islands National Insurance Company (CINICO) invites applications from suitably qualified Caymanians for the post of:

Reporting to the Chief Operating Officer (COO), the post holder will be responsible for actively managing the claims department while ensuring accuracy as well as compliance with policy and procedure in the settlement of claims.

Principal Accountabilities

• Managing the day-to-day claims operations, including claims processing, adjudication and customer service, in accordance with agreed quality and production standard;
• Managing a staff of claims professionals which includes Claims Adjudicators and Claims Administrators, including the regular and timely evaluation of their performance;
• Working closely with overseas Third Party Administrators (TPAs) and providers, to ensure quality management of overall claims processing;
• Reporting metrics, and assisting senior management with developing and establishing policies and procedures;
• Investigating enquiries, and ensuring compliance with policies and procedures in the settlement of claims;
• Working closely and maintaining good, professional working relationships with superiors, subordinates and other department managers and personnel.
• Establish and oversee Provider Networks.
• Adherence to organizational goals, objectives, standards of performance, and policies and procedures, ensuring compliance with quality patient care as well as regulatory compliance;
• May also be required to represent CINICO on other Boards, Committees, Panels or similar bodies of governance;
• Must be willing to undertake additional duties as required by the Chief Operating Officer (COO) and other Senior Management from time to time, including travel and staff training.

Qualifications and Experience

• Bachelor's degree in a related area, and at least 7 years of experience in the Health Insurance Industry, preferably in claims;
• Industry continuing education such as ICA, CII, IIA, LOMA or ICD9/10 & CPT Coding certifications are an advantage;
• Proficiency in all aspects of communication: Written & Verbal;
• Highly organized, self-motivated, capable of working under own initiative, reliable, tactful, function well under pressure, and an expert in multitasking;
• Elevated level of critical thinking and resolution skills, and must be well versed in all aspects of confidential information management;
• High level of computer literacy, with proficiency in Microsoft Outlook, Excel and Word;
• Good interpersonal skills and be able to work well within a team structure, be detail oriented with keen attention to timeliness and accuracy;

Working Conditions

This role encompasses normal office working conditions with additional hours required during peak claims submission periods.

Salary will be commensurate with experience and qualification. Pension and health insurance benefits are provided as required by law.