Claims Adjudicator I in Nassau

• Process international claims (Primary Responsibility of Claims Adjudicator II)
• Provide back-up support to Claims Supervisor and Manager
• Processes simple/moderate 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.
• Reviews claim forms, medical bills, and reports to determine nature of illness/injury

Key Responsibilities

• Maintain established claims productivity levels.
• Process international claims (Primary Responsibility of Claims Adjudicator II)
• Provide back-up support to Claims Supervisor and Manager
• Processes simple/moderate 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.
• Reviews claim forms, medical bills, and reports to determine nature of illness/injury

Knowledge & Skills

• Minimum 2 years’ experience or equivalent knowledge
• Associate’s Degree or equivalent preferred;
• Loma 280, 290, ACS, PAHM, ALHC, ARA and Underwriting, FLMI Designation or Equivalent
• Certified American Academy of Professional Coders or Knowledge of CPT and ICD-9 and ICD-10 coding and claims adjudication rules and edits
• Must be highly computer literate, especially with Microsoft Office suite of products

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