Benefits & Claims Services Associate

Reporting to the Manager of Claims & Customer Service, you will be responsible for assisting members, providers, brokers, and employers with benefit inquiries, claims processing, eligibility, network, and medical management questions.

The ideal candidate will have a strong background in health insurance and claims processing, along with excellent customer service and problem-solving skills.

What you’ll do

• Receive phone calls and written inquiries regarding benefits, claims, eligibility, and other business areas.
• Process medical, dental, and vision claims as directed.
• Provide accurate and timely responses to client inquiries.
• Process incoming requests according to established department policies and procedures.
• Conduct research and investigative activities to resolve inquiries fully.
• Collaborate with team members and other departments to resolve and escalate inquiries as needed.
• Provide timely feedback to customers through outbound calling, email, or mail.
• Report service failures, systemic issues, or customer concerns to management.
• Assist in completing special projects and evaluating and revising department policies and procedures.
• Document and write policies & procedures as needed.
• Meet or exceed service level agreements for the member services team.
• Attend and participate in meetings and training sessions as required.
• Perform other duties as assigned.

What you’ll bring

• Minimum of 2 years of experience in health insurance and 1 year of claims processing experience.
• Expert-level knowledge of CPT/CDT/ICD coding.
• Strong understanding of healthcare billing and claims.
• High level of resolution skills and proficiency in managing confidential information.
• Clear verbal and written communication skills.
• Proficiency in Word, Excel, and computer skills at an experienced level.

Join our client’s team and help us deliver exceptional service to our clients while contributing to a positive and dynamic work environment. Apply today to make a meaningful impact!
 

Caymanians or those with Caymanian rights to work need only apply.