Group Claims & Administration Manager

COLINA INSURANCE LIMITED HAS AN OPENING FOR THE POSITION OF:

GROUP CLAIMS & ADMINISTRATION MANAGER

FUNCTION SUMMARY

Management and Supervision of the Group Claims & Administration aspects of the Departments to include ongoing evaluation of processes and established turnaround times. To ensure the highest level of confidentiality, professionalism, efficiency, continuity and adherence to the Company’s standards for service excellence

Colina Insurance Company is seeking to hire a Group Claims & Administration Manager to join our Group Health & Benefits Department.

Essential Duties:

• Accurate and fair adjudication of health claims in accordance with the terms and conditions of the policy contract
• Close monitoring of claims to ensure payment within the then determined turnaround standards with an acceptable accuracy rate. This includes individual productivity standards.
• Close monitoring of pending claims.
• Manage all aspects of the subrogation function to ensure recovery of claim payments from responsible third parties
• Manage all aspects of the reinsurance function to ensure recovery of the reinsurer’s portion of the claim.
• Case Management – evaluate the appropriateness and cost-effectiveness of medical care provided locally and overseas.
• Accurate and prompt verification of benefits, referrals and precertification
• Accurate and timely payment of monthly agents/brokers’ commissions.
• Management of related human resources related matters to ensure that there is minimal disruption to the day-to-day operations and staff training and development to meet job expectations.
• Ensure that policies and procedures for all roles and processes are established, maintained and clearly communicated to staff
• Assist with monthly reporting on the department’s pertormance
  Coordination of weekly medical committee meetings and ensure that the necessary documentation including medical notes and Colina’s recommendations are shared with the reinsurer regularly.

Required Skills:

• Comprehensive knowledge of all functions and processes of the Group Claims & Administration functions.
• Proficient use of Microsoft Office tools and computer skills
• Excellent writing, communication and numeric skills
• Comprehensive knowledge of Current Procedural Terminology (CT)
• Comprehensive knowledge of International Classification of Diseases (ICD-10)
• Knowledge of medical terminology
• Comprehensive Knowledge of the Group administration and claims systems.
• Comprehensive Knowledge of Group & Individual Medical product features, contractual conditions, limitations and exclusions.

Qualifications & Experience:

• Bachelor’s Degree or equivalent work experience
• FLHC or HIAA designation
• Minimum of 5 years working in a managerial role in a health claims and administration function

Please apply via our online website: https://www.colina.com/ on our before March 31, 2025.

COLINA