ABOUT US
‘First’ is more than our name, it’s our nature. Cayman First is an industry-leading Property amp; Casualty insurer delivering best-in-class products and services to respond to the changing needs of individuals, households and businesses. Through our carefully selected network of agents and brokers, we provide protection for our customers today and prepare them for a brighter tomorrow. In June 2022, global credit rating agency AM Best affirmed the A- (Excellent) Financial Strength Rating of Cayman First Insurance and affiliate Bahamas First General Insurance. The outlook of these ratings is stable. The outlook of our credit ratings has also been deemed as stable. Our consistent rating demonstrates the long-term financial stability of the company and the larger group we are a part of.
PURPOSE OF JOB
The Health Claims Examiner is responsible for handling, evaluating, and assessing healthcare claims for our customers in accordance with applicable policy and service standards. You will play an important role by supporting work efforts of the Claims team all while prioritizing customer service excellence.
At Cayman First Insurance, we offer a supportive environment that encourages collaboration fosters professional growth.
JOB RESPONSIBILITIES
- Investigate claims to determine eligibility based on policy provisions.
- Thoroughly review health claim submissions, documentation, and data-entry.
- Perform detailed analysis to determine if additional information or documentation is required.
- Utilize critical thinking and solid judgment to solve problems, make decisions, and resolve complex issues inherent in handling losses.
- Refer claims outside of authority level, preparing referral documentation and materials as appropriate.
- Investigate potentially fraudulent claims and take appropriate action.
- Answer phone calls and respond to emails regarding policy coverage or claims and provide/request information as needed.
- Prepare correspondence (letters, email, etc.) to customers, providers, and third parties as needed.
- Record all information, conversations, and decisions relating to each claim on the system.
- Liaise with other departments to solve queries as necessary.
- Be ready to step up and support the Claims team during busy periods by taking on additional tasks and responsibilities.
- Contribute to achieve monthly performance objectives.
- Take on additional tasks and responsibilities as assigned by the Claims manager
Requirements
- An associate degree or equivalent experience in a related field.
- Three years’ experience in the health insurance industry.
- Strong analytical skills, investigative and negotiation skills.
- Excellent verbal and written communication skills.
- Demonstrated time management and organizational skills.
- Excellent Interpersonal skills, with demonstrated ability to communicate effectively with all stakeholders.
- Good understanding of MS office applications, Outlook, Excel, Word, and PowerPoint
- Knowledge of medical terminology an asset.
- One professional designation in health insurance, such as HIA or ALHC would be considered an asset.
Benefits
Cayman First offers a competitive compensation package with eligibility for a discretionary bonus, subsidized health insurance for employees and dependents, preferred home and motor insurance, a great company culture and work life balance. Compensation will be commensurate with experience and qualifications.