Claims Examiner

San Pedro Sula, Cortes, Honduras

Full Time

Experienced

*Please Upload Your Resume in English*

Position: Claims Examiner

Key Responsibilities:

Analyzing, processing, researching, adjusting and adjudicating claims which will result in a payment or non-payment of a claim with minimal guidance.
Review insurance policies, the claim form and supporting documentation to make sure that all of the information is correct. They determine whether the claims are covered under the policies issued to that policyholder.
Provide the insured with correspondence that is clear, concise and meets state regulations in relation to the decision they made on the claim processed.
Assist in identifying, investigating and reporting fraudulent claim activity to our internal fraud unit.
Provide customer service telephone support for benefit and claim inquiries

Required Skills and Experience:

Minimum of 1-year health care claims adjudication experience. Will accept education or training in a related field in lieu of experience.
Intermediate knowledge of Microsoft Office systems to include Outlook and Word
Ability to work in a fast paced/deadline driven environment.
Basic policy coverage and insurance regulation knowledge
Verbal/written telephone communication skills
Ability to prioritize and handle multiple tasks

Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.

No Third Party Agencies or Submissions Will Be Accepted.

Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP

Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to so

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This is an On-Site position. Are you able to work in our office at Edificio Nuevos Horizontes, SPS?*

Please rate your English level:*

What is your monthly salary expectation? (In Lempiras)*

Please describe your experience with health care claims adjudication. Include the types of claims you have processed and your level of independence in decision-making.*

Do you have at least one (1) year of experience in health care claims adjudication or related education/training?*

Are you familiar with basic insurance policy coverage and healthcare insurance regulations?*

Do you have experience providing customer service support via telephone for benefit or claim inquiries?*

Have you ever identified a potentially fraudulent claim? If so, explain how you handled it and what steps you took to escalate or report the issue.*

Walk us through your process for reviewing a claim from receipt to final determination (payment or denial). What key elements do you prioritize?*

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