Senior Health Claims Adjudicator

About the role

We are looking for an experienced Senior Health Claims Adjudicator to join Guardian Life of the Caribbean Limited. In this position you will assess and adjudicate complex health insurance claims, ensure compliance with policy and regulatory requirements, and deliver fair, timely outcomes while supporting exceptional customer service.

Key responsibilities

• Coordinate review and processing of complex local, regional and overseas health claims within authorization limits.
• Authorize all claims and precertifications that exceed the limits of claim adjudicators.
• Collaborate with Medical Advisors and Technical Officers to determine overseas eligibility, pre‑existing conditions and medical necessity.
• Manage verification of benefits for insureds seeking medical attention abroad.
• Handle client escalations promptly, providing decisive, solution‑oriented responses.
• Assist in updating and maintaining claims processing procedures for health claims operations.
• Provide training and mentorship to junior claims team members.

Required profile

• Strong analytical mindset with meticulous attention to detail.
• Proven experience in health claims adjudication, including complex and overseas cases.
• Ability to interpret policy and regulatory guidelines accurately.
• Excellent communication skills for liaising with medical professionals and internal teams.
• Leadership capability to train and support junior staff.
• Decisive in time‑sensitive situations and solution‑focused.

Required skills