Location: Suva, Fiji

Position: Claims Consultant

“Ensure that the candidate has working rights in Fiji” 
At Capital Insurance Group, we are proud to have a team of over 120 dedicated professionals serving a network of more than 500,000 customers across Papua New Guinea, Fiji, Tonga, Vanuatu, and the Solomon Islands. We are committed to delivering exceptional service and driving sustainable growth as we continue to shape the future of insurance across the Pacific.

About the Role

We are seeking a diligent and detail-oriented Claims Consultant to join our dynamic Claims team. Based at our Suva Office in Fiji, the successful candidate will be responsible for the timely and accurate processing of outpatient medical claims. The role requires a strong finance or accounting background to ensure financial accuracy, cost control, and compliance with policy terms and regulatory requirements.

Key Responsibilities Include

• Analyze claims data and apply financial expertise to detect irregularities, ensure correct billing, and prevent fraud.
• Reconcile processed claims with finance systems to ensure accurate payouts.
• Maintain accurate claims records and documentation for auditing and reporting purposes.
• Support the finance and actuarial teams by providing claims data analysis and cost trend reporting.
• Receive, assess, and process outpatient medical claims in line with company policies, provider contracts, and regulatory standards.
• Verify the completeness, accuracy, and eligibility of submitted claims.
• Collaborate with healthcare providers and clients to resolve claim queries and discrepancies.
• Assist in reviewing outpatient benefit utilization and suggest process improvements to enhance efficiency and cost control.
• Adhere to service level agreements and uphold high standards of customer service.

 

Qualifications & Experience

• A tertiary qualification in Finance, Accounting, Insurance, or a related field.
• 2–3 years of experience in claims processing, ideally within a health or general insurance environment.
• Strong knowledge of outpatient medical procedures, terminology, and health insurance policies.\
• Sound understanding of financial principles and accounting systems, including reconciliation processes.
• Proficiency in Microsoft Office Suite, particularly Excel; experience with claims processing systems is an advantage.
• Excellent analytical, communication, and problem-solving skills.
• High attention to detail, with a strong focus on accuracy and confidentiality.

Benefits

• Competitive salary and benefits package.
• Performance-based bonus opportunities.
• Comprehensive health coverage.
• A supportive, purpose-driven work culture.
• Opportunities for professional development and career growth.

How To Apply

Please send your resume and cover letter to cilhr@capgrp.com.

Application Deadline:

Applications close on 9th May 2025 at 4:00 PM [Fiji Time].