Postúlate en Kit Empleo: kitempleo.com.co/empleo/1azoff

Schedule

Monday – Friday, 7:30 a.m. to 5:00 p.m. (COT) – Hybrid

Type of Contract

Permanent with benefits (Colombian Law)

Description

The Claims Analyst is responsible for evaluating and processing claims in accordance with policy benefits and contractual conditions for a leading organization in the insurance sector. This role ensures high-quality standards through the accurate adjudication of claims, maintaining meticulous attention to detail and strict adherence to policy guidelines. The successful candidate will act as a key link in the claims lifecycle, ensuring precision in financial distributions and compliance with medical and legal frameworks.

Key Responsibilities

- Review and adjudicate claims based on specific policy benefits and contractual terms.
- Refer claims to the medical department for coverage analysis in specialized or complex cases.
- Generate and manage detailed claims reports to ensure operational transparency.
- Perform CTP coding and ICD-10 coding to ensure accurate and standardized processing.




- Validate banking information to ensure correct and timely payment distribution.
- Associate medications with presented diagnoses to verify coverage eligibility.
- Validate expenses in relation to coverage renewal dates and specific policy timelines.
- Calculate expenses and deductibles per policy year with high precision.
- Validate waiting periods and verify pre‑existing conditions, exclusions, and deductible increases.
- Validate service dates and perform necessary currency conversions for international or multi‑currency claims.
- Apply general policy benefits according to the specific plan contracted by the user.

Requirements

- Education: Student or professional degree in Business Administration, Finance, or related fields.
- Experience: Minimum of two years of experience in claims processing or a related role within the insurance sector.
- Customer Service: Demonstrated experience providing high-quality customer service and conflict resolution.

#J-18808-Ljbffr

Postúlate en Kit Empleo: kitempleo.com.co/empleo/1azoff

📌 Claims Adjudicator (Oriente Antioqueño) (Colombia)
🏢 ttg Talent Solutions
📍 Colombia