***Only resident applicants will be considered, preference will always be given to Caymanians***
Reporting to the General Manager, the Claims Manager will be responsible for ensuring compliance to procedures, proper services, and settlement of claims while actively managing the claims department to achieve quality service to our members and accuracy in claim settlement.
- The post holder will be responsible for managing day to day workflow of the claims department, monitoring personnel performance training needs and counseling.
- They will also be required to implement, manage and provide support & expertise to enhance cost mitigating strategies, through comprehensive assessment, planning, and the overall evaluation of claims both local and overseas.
- The post holder will be responsible for managing the day-to-day claims operations, including claims evaluation; adjudication and customer service in accordance with agreed quality and production standards.
- Manages staff of claims professionals, which may include a Sr. Claims Administrator, Claims Administrators and administrative support personnel, including the regular and timely evaluation of their performance.
- Work closely with overseas Third Party Administrators (TPA), to ensure quality management of overall claims processing.
- Report metrics, and assist senior management in developing and establishing policies and procedures.
- Investigates out of guidelines inquiries, and ensures compliance to procedures, proper services and settlement of claims.
- Work closely and maintains good, professional working relationship with superiors, peers, subordinates and other department managers and personnel.
- Bachelor’s degree in a related area and at least 7 years of experience in the Health Insurance Industry preferably in the claims area.
- Industry continuing education such as ICA, CII, IIA, LOMA or ICD9/10 & CPT Coding certifications is an advantage
- The successful candidate must also possess an elevated level of resolution skills and be well versed in all aspects of confidential information management.
- The Post holder must liaise effectively with the CEO, other senior and administrative staff, the Company’s various service providers,as well as members of the public.