Claims Examiner

Temp to Full Time

Claims Examiner

100% remote Toronto or Calgary

Job Overview

You are an experienced Claims Examiner who can handle a large case load, multi-task, and meet tight deadlines. You thrive in a fast-paced environment providing excellent customer service in both the turnaround of the claim and handling emails and incoming calls. You will have the desire to develop an in-depth understanding of this position and be able to easily maneuver through numerous policies to accurately assess claims and inquiries. You are a very strong team player.

The Claims Examiner will be responsible for processing a variety of different claims and communicating these decisions to providers, members, and clients. This role requires strong time management skills, claims experience, and policy interpretation.

Responsibilities

• Process travel insurance claims for medical, trip cancellation/interruption, baggage, dental and vision claims up to the designated limit

• Adjudicate claims according to various benefit policies

• Handle both inbound and outbound calls, complaints, provide excellent customer service for claims matters both in person and via written correspondence

• Work closely with claimants, providers, agents, brokers, other insurance carriers or their representatives

• Work closely with other departments within the company on a day-to-day basis

• Maintain accurate documentation on all claim files

• Adjust reserves in accordance with the insurer’s guidelines

• Present cases and participate in discussions during file reviews and appeals

• Ensure all work complies with the PIPEDA and HIPAA

• Support department initiatives and objectives

• Provide guidance and mentorship to peers

• Other related duties as assigned

Qualifications and Education Requirements

• High school diploma or University Degree or equivalent

• Minimum 2-3 years of relevant travel insurance or medical insurance claims processing experience

• Bilingual: English/French is required

• Strong analytical and problem-solving skills

• High level of proficiency in Microsoft Office suites

• Superior verbal and written communication skills in English and/or French

• Strong time management and organizational skills