Role Purpose
The Accident and Health Claims Adjuster is responsible 
for the review, assessment, and management of A&H claims in a timely, fair, and accurate manner, ensuring compliance with policy terms, regulatory requirements and customer service standards.. 
Key Responsibilities
•    Review and analyze A&H claims to determine coverage and eligibility under policy terms. 
•    Communicate with policyholders, brokers, healthcare providers, and internal stakeholders to obtain necessary information and provide claim updates.
•    Make timely decisions on claim approval, partial payment, or denial with clear justifications.
•    Identify potential fraudulent claims and refer cases as necessary for investigation.

Requirements
•    Bachelor’s  Degree in Business Administration. 
•    Adjusters License from the Office of the Commissioner of Insurance of Puerto Rico (OCS).
•    Demonstrated experience and/or knowledge in claims related to the following coverage’s: Accident, Medical Expenses, Cancer, Critical Illnesses, Disability, Hospitalization, and SINOT, among others including policy interpretation.
•    High attention to detail and accuracy.
•    Ability to manage multiple claims and meet deadlines.
•    Demonstrate flexibility and adaptability to work in a fast moving and challenging environment.
•    Proficient in MS Applications (Word, Excel and Power Point).
•    Intermediate knowledge of the structure and content of the English and Spanish Language.

Experience
•    Three (3) years of experience managing all major aspects of A&H claims adjustment process in the insurance industry, preferable.