Accident & Health Claims Adjuster (Finance)

JOB DESCRIPTION

Role Purpose

The Accident and Health Claims Adjuster is responsible to handle, investigate, analyze, calculate and approve insurance claims filed by policyholders and determine the extent of insurance company's liability concerning Accident and Health claims.

Key Responsabilities

• Manage, evaluate and adjust Accident & Health claims as per the policy terms and conditions including application of exclusions if applicable.
• Work and manage as many fast track claims as possible (Medical Expenses) and analyze medical records.
• Assist in resolving complaints from policyholders relative to claims.
• Comply with OCS, PMP objectives, Claims Best Practices guidelines & standards of services as required.
• Do coverage determination position letters to policyholders.
• Perform specials projects and other related duties as assigned.
• Make timely decisions on claim approval, partial payment, or denial with clear justifications.
• Identify potential fraudulent claims and refer cases as necessary for investigation.

QUALIFICATIONS

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  ABOUT US

  Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.

  At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.