Senior Health Claims Adjudicator

About the role

Guardian Life of the Caribbean Limited is looking for an experienced Senior Health Claims Adjudicator to lead the review and authorization of complex health insurance claims. The role combines analytical assessment, compliance oversight, and mentorship of junior staff while ensuring timely, fair outcomes for policyholders.

Key responsibilities

• Coordinate review and processing of complex local, regional, and overseas health claims within established authorization limits.
• Authorize all claims and precertifications that exceed the limits of Claim Adjudicators.
• Liaise with Medical Advisors, Technical Officers, and external agencies to determine eligibility, pre‑existing conditions, and medical necessity for overseas cases.
• Handle client escalations promptly, providing decisive, solution‑oriented responses.
• Assist in updating and maintaining claims processing procedures for Trinidad & Tobago and other jurisdictions.
• Provide training and guidance to junior claims adjudicators.

Required profile

• Strong analytical mindset with attention to detail.
• Excellent knowledge of health insurance policies, regulatory requirements, and medical terminology.
• Proven experience in adjudicating complex or high‑value claims.
• Effective communication skills for interacting with medical professionals and clients.
• Ability to work under time‑sensitive conditions and resolve issues decisively.

Required skills