Specialist, Health Claims

About the role

The Specialist, Health Claims supports the financial operations of Carnival Corporation’s Health Services division by performing core activities across health claims processing, accounts payable, and financial analysis.

Responsibilities

• Manage high-cost and complex medical claims, ensuring timely cost recording and closure.
  • Appropriately identify and escalate high-cost or complex cases to Management.
  • Oversee the complete inventory of claims, including monitoring and reporting open, pending and close claims.
  • Track claim aging and follow up on unresolved invoices to ensure timely closure.
  • Cook up with providers, insurance, and third-party administrators regarding the invoice status and documentation.
  • Maintain claim reserves and update financial projections as needed.
  • Investigate claim discrepancies, overpayments and appeals.
• Medical invoice processing and validation.
  • Review, verify and process medical invoices ensuring accuracy of patient data, diagnoses, procedure/services billed, and billing amounts.
  • Demonstrate a strong attention to detail in the review and processing of all payments.
  • Process medical reimbursement with a high level of precision, ensuring compliance with policy requirements and proper documentation.
  • Identify discrepancies, overbilling, and coding errors; escalate complex cases to Finance Managing team.
  • Review and approve medical invoices within delegated authorization limits, ensuring accuracy, compliance with company policies, and appropriate supporting documentation.
  • Maintain compliance with internal policies, insurance guidelines, and regulatory standards.
• Financial reporting & analytics.
  • Maintain reporting tools and dashboards to track overall P&I cost, monitor financial trends, and support cost containment initiatives.
  • Develop and maintain dashboards and reports to monitor open vs. closed claims, turnaround times, and financial impact.
  • Aid in monthly financial reporting by compiling expense data, validating entries, and preparing summaries.
  • Support ad hoc financial analysis, special projects, and operational reviews.
• Cross-functional support & compliance.
  • Partner with Case Management and Health Operations teams to support claims review and financial inquiries.
  • Maintain confidentiality of sensitive medical and financial information.
  • Support continuous improvement initiatives related to claims workflows, AP processes, and financial reporting.
  • Perform other duties as assigned.

Requirements

• Bachelor’s degree in Business, Finance, Accounting, or Healthcare Administration.
• Certified Professional Biller (CPB) or similar medical billing and coding credential (e.g., CMRS, CBCS) preferred.
• 2+ years of experience in healthcare finance, claims processing, medical billing, AP, or related field.
• Experience with medical claims, billing codes, or vendor payment systems preferred.
• Experience with Excel, Power BI, PowerApps, or other financial/claims systems preferred.

Qualifications

• Strong time management and organizational skills.
• Ability to maintain reliable and consistent attendance.
• Capacity to be punctual and meet deadlines.
• Ability to collaborate effectively with colleagues and work as part of a team.
• Demonstrated professionalism in all interactions and tasks.

Skills

• Problem solving.
• Interpretation of data trends.
• Assessment of root causes of payment delays or claim variances.
• Recommendations for improving cost containment and operational efficiency.

Benefits

• Annual cash bonus program.
• Discretionary equity incentive plan.
• Comprehensive and innovative benefits.
• Health Benefits: Cost-effective medical, dental and vision plans.
• Employee Assistance Program and other mental health resources.
• Additional programs include company paid term life insurance and disability coverage.
• Financial Benefits: 401(k) plan that includes a company match.
• Employee Stock Purchase plan.
• Paid Time Off: Holidays, Vacation Time, Sick Time.
• On-site Fitness center.