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Trinidad & Tobago
Position: Group Claims Examiner
Location: Trinidad and Tobago
JOB SUMMARY
The incumbent is required to provide support towards the successful achievement of operational objectives established for the Claims Department. The incumbent is responsible for settling all valid claims in an efficient and prompt manner in accordance with assigned quotas and expectations.
RESPONSIBILITIES
- Processing of claims
- Receives claim submissions and relative documents from customers.
- Prepares file, establish and maintain reserves.
- Requests Medical Consultant to conduct medical investigations.
- Reviews reports to determine extent of coverage as required.
- Consults with Supervisor on details of claims as required.
- Consults with Medical support personnel on details of claims.
- Adjudicates claims in line with established standards.
- Follow‑up on all pending claims.
- Estimates and VOBs
- Completes dental, vision and medical estimates and verification of benefits.
- Payment processing
- Ensures the timely completion of ACH / WT uploads within standards.
- Administration of ACH rejects.
- Maintain records/file
- Inputs/updates data entry into claims systems.
- Queries, Requests and Reporting
- Prepares/generates statistical reports as required.
- Reviews and resolves assigned queries.
- Provides support to all audit requests.
- Reviews outstanding files.
- Performs other relate duties that may be assigned.
QUALIFICATIONS AND EXPERIENCE
- Associate Degree in Business Management, Accounting or similar field.
- Two (2) Advanced level passes inclusive of Accounting or equivalent.
- Five (5) G.C.E./C.X.C passes including English Language and Mathematics.
- Three (3) to Five (5) years’ working experience in a similar capacity would be an asset
- Insurance related courses and training programs would be considered an asset
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