- 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 firstname.lastname@example.org by September 30, 2020.
FamGuard thanks all applicants; however, only those short-listed will be contacted.
Claims Adjudicator III