Senior Claims Adjudicator

Senior Claims Adjudicator

Odyssey Reinsurance Company (OdysseyRe) is the global reinsurance arm of Odyssey Group, one of the world's leading providers of reinsurance and specialty insurance. OdysseyRe offers a broad range of property, casualty, and specialty reinsurance products, providing capital and risk management solutions for clients to efficiently manage economic risk, through a network of branch and representative offices across North America, Latin America, EMEA (Europe, Middle East & Africa), AsiaPacific and London. OdysseyRe is an equal opportunity employer with excellent benefits and a strong commitment to providing training and opportunities for our staff. We provide employees an innovative, enriching environment and take great pride in their career growth. OdysseyRe is rated A+ (Superior) by AM Best and AA- (Very Strong) by Standard and Poor's. Odyssey Group is a subsidiary of Fairfax Financial Holdings Limited, which is traded on the Toronto Stock Exchange under the symbol FFH.

Summary: Responsible for reviewing and adjudicating medical claims to ensure accurate, timely reimbursement, interpreting contract provisions and eligibility requirements, researching fee schedules, and collaborating with claims staff, underwriters, and brokers to resolve inquiries and support claims-related decisions.

Responsibilities:

• Adjudicate claims for timely review and appropriate reimbursement
• Analyze claims data to determine eligibility and apply appropriate contract provisions to the medical facts of the claim
• Work with claims staff, underwriters, and advise brokers on adjudication results and resolve claim inquiries
• Provide support for inquiries on adjudication methods and outcomes to claims staff
• Research and review state reimbursement fee schedules
• Other support requirements, as necessary

Qualifications:

• Bachelor's degree (or equivalent college education)
• 10+ years of claims adjudication, claims processing, health insurance, or related experience
• Strong attention to detail and organizational skills
• Knowledge of medical terminology, insurance benefits, and claims adjudication principles
• Ability to interpret plan documents, contract provisions, eligibility requirements, and reimbursement guidelines
• Clear written and verbal communication skills
• Ability to work well independently as well as within a team environment
• Proficiency (Microsoft Office Product Suite)

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