Health Claims Adjudicator

HEALTH CLAIMS ADJUDICATOR

SALARY: CI$58,380 -$78,516

Reporting to the Health Claims Manager, the post holder will be responsible for adjudicating health insurance claims to a high degree of accuracy, while ensuring compliance with turn-around times established in legislation as well as adherence to company and departmental policies.

Principal Accountabilities

• Evaluate and process medical and dental claims in accordance with company policies and procedures as well as medical necessity, appropriateness, and billing guidelines.
• Review and analyze data for in-process claims in order to identify and resolve errors prior to finalizing payment.
• Determine accurate claims payment or denial.
• Identify, investigate and appropriately address dubious claims.
• Identity system problems/issues and notify appropriate parties for resolution
• Investigate claims for possible third party liability.
• Exercise good judgement, remain knowledgeable in related company policies and procedures, and adhere to organizational goals.
• Ensure compliance with quality patient care and regulatory requirements.
• Any other duties that may be assigned by the Claims Manager and Senior Management as required from time to time.

Qualifications and Experience

• Bachelors degree or higher in a related area, and a minimum of 3 years of experience in adjudicating and auditing claims;
• Industry certification such as ICA, CII, IIA, LOMA, AHIP or ICD10 & CPT Coding are an advantage;
• Strong knowledge of claims processing guidelines, ICD10, CPT coding, coding edits, claim forms, health benefit plans and medical terminology;
• Proficiency in all aspects of communication: Verbal and Written;
• Must be highly organized, self-motivated, capable of working under own initiative, reliable, tactful, function well under pressure, and an expert in multitasking;
• Must possess an elevated level of analytical and resolution skills, and be well versed in all aspects of confidential information management;
• High level of computer literacy, with proficiency in Microsoft Outlook, Excel and Word;
• Good interpersonal skills, ability to work well within a team structure, and detail orientated with keen attention to timeliness and accuracy.

Salary will be commensurate with experience. Pension and health insurance benefits are provided as required by law. To Apply follow the link: https://cinico.bamboohr.com/careers/31 Alternatively, please visit our CINICO website career page and apply: www.cinico.ky/career APPLICATION DEADLINE: 23 October 2026