A&H Claims Adjuster

Role Purpose The Accident and Health Claims Adjuster isresponsible to handle, investigate, analyze, calculate and approve insurance claims filed by policyholders anddetermine the extent of insurance company's liability concerning Accident andHealth claims. Key Responsibilities Manage, evaluate and adjustAccident & Health claims as per the policy termsand conditions including application of exclusions if applicable. Work and manage as many fasttrack claims as possible (Medical Expenses) and analyze medical records. Assist in resolvingcomplaints from policyholders relative to claims. Comply with OCS, PMPobjectives, Claims Best Practices guidelines & standards of services asrequired. Do coverage determinationposition letters to policyholders. Perform specials projectsand other related duties as assigned. Requirements Bachelor's Degree in Business Administration. Adjusters License from the Office of the Commissionerof Insurance of Puerto Rico (OCS). Demonstrated experience and/or knowledge in claimsrelated to the following coverage's: Accident, Medical Expenses, Cancer,Critical Illnesses, Disability, Hospitalization, and SINOT, among othersincluding policy interpretation. Strong ability to perform mathematical calculations. Demonstrate flexibility and adaptability to work in afast moving and challenging environment. Proficient in MS Applications (Word, Excel and PowerPoint). Intermediate knowledge of the structure and content ofthe English and Spanish Language. Experience Three (3) years of experience managing all majoraspects of A&H claims adjustment process in the insurance industry,preferable. SDL2017

Ciudad: san juan