Health Claims Specialist: Precise Adjudication & Compliance

Cayman Islands National Insurance Company; George Town; On-site; MYR 287,000 - 385,000; Full time

Job summary

CAYMAN ISLANDS NATIONAL INSURANCE COMPANY (CINICO) is seeking a Health Claims Adjudicator to adjudicate health insurance claims with accuracy and adherence to legislation, policies and turnaround times. You will join a team processing a high volume of claims monthly.

The role requires a Bachelor’s degree or higher, 3+ years of adjudicating/auditing claims, and relevant certifications. Strong analytical and communication skills, plus proficiency in MS Office, are essential.

Qualifications

• Bachelor’s degree or higher in a related area with at least 3 years of adjudicating and auditing claims.
• Industry certification such as ICA, CII, IIA, LOMA, AHIP or ICD10 & CPT Coding.
• Strong knowledge of claims processing guidelines, ICD10, CPT coding, coding edits, claim forms, health benefit plans and medical terminology.
• Proficiency in communication: verbal and written.
• Must be highly organized, self-motivated, reliable, able to work under pressure, and able to multitask.
• Analytical and confidentiality management skills.
• High computer literacy with MS Outlook, Excel and Word.
• Good interpersonal skills and detail orientation.

Responsibilities

• Evaluate and process medical, vision and dental claims in line with policies and guidelines.
• Meet or exceed daily claim processing targets.
• Review and analyze data for in-process claims to identify and resolve errors before payment.
• Determine accurate claims payment or denial.
• Identify, investigate and address dubious claims.
• Identify system problems and notify relevant parties for resolution.
• Investigate claims for potential third-party liability.
• Maintain compliance with quality patient care and regulatory requirements.
• Perform other duties as assigned by management.

Skills

Claims adjudication

Auditing claims

Analytical skills

Multitasking

Time management

Verbal and written communication

Education

Bachelor’s degree or higher in a related area

Tools

Microsoft Outlook

Microsoft Excel

Microsoft Word

Job description

CAYMAN ISLANDS NATIONAL INSURANCE COMPANY (CINICO) is seeking a Health Claims Adjudicator to adjudicate health insurance claims with accuracy and adherence to legislation, policies and turnaround times. You will join a team processing a high volume of claims monthly.

The role requires a Bachelor’s degree or higher, 3+ years of adjudicating/auditing claims, and relevant certifications. Strong analytical and communication skills, plus proficiency in MS Office, are essential.