The Role
Manages the Claims and Provider Relations team, ensuring claims and pre-authorization requests meet service-level requirements. Oversees provider network performance, conducts audits, maintains departmental SOPs and processes, monitors KPIs, prepares reports, and participates in meetings. Requires health insurance management experience, relevant professional certifications, Microsoft Office proficiency, and reliable vehicle ownership.
Summary Generated by Built In
SUMMARY OF DUTIES
- Supervision and leadership of the Claims & Provider Relations Team.
- Ensure claims are processed in accordance with established client service level agreements.
- Ensure that pre-authorization requests are processed in accordance with established service guidelines.
- Maintain and monitor the provider network in accordance with established company KPIs.
- Conduct routine and ad hoc audits as and when required.
- Establish and update the department's SOP and processes.
- Prepare reports and attend meetings as and when required.
QUALIFICATION & EXPERIENCE
- First Degree in Management Studies, Business Administration or related discipline.
- At least 5 years' management experience in the health insurance industry in a similar capacity.
- Adept in Microsoft Office Suite (with emphasis on Microsoft Excel)
- Health Insurance Associate (HIA) Designation.
- Life Office Management Association Certification (Parts i and ii)
- Must own and operate a reliable motor vehicle.
Skills Required
- First degree in Management Studies, Business Administration, or a related discipline
- At least 5 years of management experience in the health insurance industry in a similar capacity
- Proficiency in Microsoft Office Suite, especially Microsoft Excel
- Health Insurance Associate designation
- Life Office Management Association Certification, Parts I and II
- Own and operate a reliable motor vehicle
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The Company
What We Do
Canopy Insurance Limited is a Jamaican, technology-driven health and life insurer backed by GraceKennedy and the Musson Group. It provides group health and life coverage, especially for employers, and uses modern technology and dedicated insurance expertise to simplify administration. Its mission is to deliver hassle-free, innovative life and health insurance solutions, combining customer care with technology to improve the insurance experience for clients.
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