Senior Health Claims Manager

Cayman Islands National Insurance Company; George Town; Sur place; MYR 368 000 - 614 000; Plein temps

Résumé du poste

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.

Qualifications

• 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.

Responsabilités

• 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.

Connaissances

Claims adjudication

Staff management

Quality assurance

Regulatory compliance

Provider networks

Data reporting

Customer service

Communication

Formation

Bachelor's degree in a related area

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

Outils

Microsoft Outlook

Excel

Word

Description du poste

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.