Specialist, Health Claims

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. This role is responsible for the review, investigation, adjudication, and oversight of medical claims to ensure accuracy, compliance, and cost-effective claim management. The Specialist, Health Claims serves as a key liaison between case management team, healthcare providers, insurance carrier, and internal stakeholders to facilitate timely claim resolution, monitoring high-cost cases, validate supporting documentation, and maintain appropriate financial reviews. The Specialist analyzes medical expenses, identifies discrepancies, supports reporting and trend analysis to ensure adherence to plan provisions, regulatory requirements, and organizational policies. Additionally, the position contributes to the development of claims management strategies, escalation of complex cases, and continuous improvement of claims administration processes to optimize outcomes and control healthcare cost. They are responsible for developing and maintaining complex economic models to evaluate financial impact, including the maintenance of dashboards and reports to monitor KPIs. The role will also support the development, implementation and the monitoring of department financial performance. The role requires strong attention to detail, analytical capability, experience in medical claim management, and the ability to communicate effectively with internal teams and external providers. This position interfaces with all brands, shipboard medical teams, shoreside health services, and external vendors supporting Carnival’s global healthcare ecosystem. Essential Functions: MANAGEMENT OF CLAIMS 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. Coordinate with providers, insurance, and third-party administrators regarding the invoice status and documentation. Monitor 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. Ensure alignment with contracted rates, term dates, benefit eligibility, and documentation requirements. 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. Support monthly financial reporting by compiling expense data, validating entries, and preparing summaries. Assist with 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