Claims Adjudicator III

Application Deadline: 30 September, 2020Apply Now
Job Description

PRIMARY RESPONSIBILITIES:

 

  • Reviews claim forms, medical bills, and reports to determine nature of illness/injury
  • Processes complex claims based on medical benefits, system data, case histories, plan documents, Claims Procedure Manual, MAG Mutual Physicians Fee & Coding Guide and Medical Association of the Bahamas guidelines
  • Process international claims
  • Coordinate pre-determination of benefits
  • Maintain established claims productivity levels
  • Assist with preparation of financial and operational reports
  • Demonstrates professionalism, knowledge, initiative, innovation to increase level of customer satisfaction and profitability of the organization

 

KNOWLEDGE & SKILLS:

 

  • Minimum 5 years’ experience or equivalent knowledge
  • Bachelor’s Degree or equivalent preferred;
  • ACS, PAHM, ALHC, FLMI Designation or Equivalent
  • Certified American Academy of Professional Coders or Knowledge of CPT and ICD-9 coding and claims adjudication rules and edits
  • Ability to communicate effectively, both orally and in writing
  • Excellent organizational skills
  • Must be highly computer literate, especially with Microsoft Office suite of products
  • Ability to investigate and analyze information, and refer findings appropriately.
  • Must exhibit a high level of confidentiality

Resumés with accompanying certificates should be forwarded via email to careers@familyguardian.com by September 30, 2020.

 

FamGuard thanks all applicants; however, only those short-listed will be contacted.

Role:

Claims Adjudicator III

Employment Type:

Full Time