
Reporting to the Operations Manager, Assistant General Manager, Director of Operations, you will be responsible for the overall leadership, management, and strategic oversight of the Claims Department in Bermuda, ensuring the accurate, timely, and cost-effective adjudication of medical, dental, vision, life, and disability claims in accordance with Company policies, contractual obligations, regulatory requirements, as well as service standards. You will manage claims operations, review complex and high-dollar claims, monitor claims quality and departmental performance, and develop operational processes that support efficient administration and effective cost management. You will serve as the primary subject matter expert for claims operations and medical claims management and work collaboratively with internal departments, healthcare providers, external vendors, brokers, consultants, and regulatory bodies to support the Company's strategic objectives.
Minimum of 10 years' medical claims experience, including local and international claims adjudication. Demonstrated experience managing high-volume medical claims operations. Extensive knowledge of medical, dental, vision, prescription drug, life, and disability benefits. Strong understanding of healthcare reimbursement methodologies, provider contracting, utilization management, and medical cost containment strategies. Strong knowledge and current proficiency in ICD-10, CPT, ADA, ODA coding systems and medical terminology. Knowledge of HIPAA and other healthcare privacy regulations is considered an asset. Experience participating in healthcare industry committees. Strong leadership, coaching, communication, analytical, organizational, decision-making, problem-solving, and strategic thinking skills. Ability to interpret complex medical documentation, work effectively under pressure and manage multiple priorities. Strong English and mathematics skills. Advanced proficiency in Microsoft Office applications and business systems.
Please apply by scanning the QR code or by visiting http://tinyurl.com/CGVacancies by no later than October 5, 2026.
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