Senior Claims Adjudicator Jobs

Career Opportunity

Role Title

Senior Claims Adjudicator

Purpose of role

As a Member of the Claims team the Sr. Claims Adjudicator will be accountable for ensuring that all claims are adjudicated and administered according to state and provincial law and regulations and in a fair, ethical and efficient manner.

Key Responsibilities:

• Perform all necessary benefit calculations and ensure all related activities are in compliance with provincial/state statutory and internal standards.
• Maintain and update system records as necessary.
• Adjudicate various types of complex claims, including Life, Critical Illness and Accelerated Death Benefit claims. This includes identifying, collecting and reviewing all relevant information needed to determine the claim legitimacy and eligibility as well as the benefit amount payable.
• Familiarization with the requirements of the appropriate provincial/state legislation and/or regulations related to the type of claim being reviewed.
• Communicate effectively with outside resources such as medical consultants, legal consultants, independent physicians, coroners, police or investigative services.
• Determine which claims need to be referred for evaluation and decision, based on authority limits, business case issues or referral to legal counsel.

Key Qualifications

• College Diploma or University Degree an asset
• Strong analytical skills for research, review and assessment of claims.
• Strong reasoning and judgment to balance commitments, financial soundness and quality customer focus
• Advanced verbal and written communication skills to effectively communicate with internal and external customers/partners and vendors.
• Knowledge of the interpretation and application of claims adjudication regulations across the United States, knowledge of Canadian regulations an asset
• Self starter with demonstrated ability to prioritize case load and ability to research/problem solve and make decisions both independently and collaboratively within a fast paced team environment
• Bilingual (French or Spanish) would be considered an asset
• 5 – 7 years experience adjudicating complex claims, including contestable claims;
• ALHC designation an asset
• Knowledge of claims adjudication theory, principles, methods, systems, processes and standards including an understanding of insurance medicine and actuarial principles/methods as they relate to the claims function.

“Internal Applications should be submitted within 2 weeks of the job posting date”.

Equal Opportunity Employment and Inclusion – at Foresters Financial, we are committed to sustaining an equal opportunity environment for all job applicants. We embrace Inclusion, Diversity and Equity (IDE) as a core strategic objective for building strong, innovative teams in which all our employees can show up wholly and authentically as themselves.

Foresters Financial strives to provide an accessible candidate experience for prospective employees with different abilities. If you anticipate needing any type of accommodations during the recruitment process, please email [email protected] in advance of your appointment.

Thank you for choosing Foresters. Only those candidates who will be selected for further consideration will be contacted by our Talent Acquisition Team.