Claims Adjudicator Health Insurance

Company DescriptionVIP Universal Medical Insurance Group (VUMI®) is an international health insurance organization offering major medical insurance products and specialized VIP medical services to individuals and corporations worldwide. VUMI provides a wide variety of health plans, including access to features such as Second Medical Opinion VIP®, global telemedicine, and at-home doctor visits. With offices across the United States, Canada, the United Arab Emirates, Latin America, and Europe, VUMI operates as part of a global healthcare management group with over 40 years of industry experience. The company employs more than 590 professionals of diverse nationalities, ensuring comprehensive global expertise and service.
Job DescriptionAnalyze and review claims, ensuring data accuracy and proper coding using CPTS and CIE10 standards.Meet established productivity targets by processing claims within defined turnaround times, accurately applying benefit schedules and plan provisions based on members’ selected coverage.Refer claims to the Medical Review Department for coverage evaluation when required.Request additional information from agencies and healthcare providers when necessary to support claim adjudication.Prepare and review claims reports to support coverage analysis and decision-making.Provide timely internal responses to pending items and inquiries from team coordinators.
Mandatory RequirementsAdvanced EnglishExperience in the Health insurance sector as AdjudicatorProficiency in Microsoft Excel and other Microsoft Office applications.Strong numerical and analytical skills.
Demonstrated high level of responsibility, organization, proactivity, and strong written and verbal communication skills.