Junior Claims Examiner - Health Insurance

ABOUT US

‘First’ is more than our name, it’s our nature. Cayman First is an industry‑leading Property & Casualty and Health 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. Cayman First maintains an A‑ (Excellent) financial strength rating from global credit rating agency AM Best.

PURPOSE OF JOB

As a Junior Claims Examiner, you will be responsible for processing group health claims while reviewing and evaluating healthcare claims for customers in line with relevant policies and service standards. Preparing responses to queries and letters within the required timeframe thus ensuring the company’s service standards are met.

JOB RESPONSIBILITIES

• Handles all types of health claims within the designated timeframe.
• Reviews and approve claims within the scope of authority.
• Investigate claims to assess eligibility based on policy terms and conditions.
• Identify potentially fraudulent claims and take appropriate actions to address them.
• Verifies eligibility and ensures pre‑certification is completed.
• Responds to phone inquiries and emails regarding policy coverage or claims, providing or requesting information as necessary.
• Prepares correspondence (letters, emails, etc.) for customers, providers, and third parties as required.
• Assists with special projects as needed.
• Consistently meet or exceed monthly performance objectives and contribute to departmental KPIs.
• Performs other duties and responsibilities as assigned.

QUALIFICATIONS

BENEFITS

Cayman First offers a competitive compensation package with eligibility for a discretionary bonus, subsidised health insurance for employees and dependants, preferred home and motor insurance, a great company culture and work life balance. Compensation will be commensurate with experience and qualifications.

#J-18808-Ljbffr