Claims Examiner Jobs

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 claim turnaround 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 assess claims and inquiries accurately. 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

• Other related duties as assigned
• Present cases and participate in discussions during file reviews and appeals
• Adjudicate claims according to various benefit policies
• Process travel insurance claims for medical, trip cancellation/interruption, baggage, dental, and vision claims up to the designated limit.
• Adjust reserves following the insurer’s guidelines
• Handle both inbound and outbound calls, and complaints, and 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
• Support department initiatives and objectives
• Ensure all work complies with the PIPEDA and HIPAA
• Provide guidance and mentorship to peers
• Maintain accurate documentation on all claim files
• Work closely with other departments within the company on a day-to-day basis

Qualifications and Education Requirements

• Strong time management and organizational skills
• Strong analytical and problem-solving skills
• Minimum 2-3 years of relevant travel insurance or medical insurance claims processing experience
• High school diploma or University Degree or equivalent
• Must successfully apply for Alberta Adjuster License within one month of hire
• High level of proficiency in Microsoft Office suites
• Bilingual: English/French is required
• Superior verbal and written communication skills in English and/or French

Preferred Skills

• GHIP recovery/coordination of benefits/subrogation
• Experience in handling Canadian and US medical invoices/claims
• Dispute resolutions experience
• Solid Team Player
• Snowbird, expatriate insurance, TPA experience

Additional Notes

• A laptop will be provided
• Our work week is Monday to Friday, 8 hours per day. The hours are flexible, with start times between 8 am and 10 am. Occasional flexibility in hours is required to meet the needs of the business.