Jr. Claims Adjudicator (Medellín)

Claims Adjudicator

Medellín

Permanent Position

Monday to Friday, 7:30 AM - 5:00 PM - Colombian Calendar / Hybrid

Description

The Claims Adjudicator is responsible for evaluating and processing claims in accordance with policy benefits and contractual conditions. Maintaining high-quality standards by ensuring accurate claims adjudication.

Responsibilities and Functions

• Review and adjudicate claims based on policy benefits.
• Submit claims for coverage analysis to the medical department in specific cases.
• Generate reports.
• CTP coding.
• ICD‑10 coding.
• Validate banking information.
• Associate medications with the presented diagnosis.
• Validate expenses with coverage renewal dates.
• Calculate expenses and deductibles per policy year.
• Validate waiting periods.
• Validate pre‑existing conditions, exclusions, and deductible increases.
• Vali...