Claims Adjudicator Living Benefits Jobs

Familiarization with the requirements of the appropriate provincial/state legislation and/or regulations related to the type of claim being reviewed.

Perform all necessary benefit calculations and ensure all related activities are in compliance with provincial/state statutory and internal standards.

5 – 7 years experience adjudicating complex claims, including contestable claims;

Knowledge of the interpretation and application of claims adjudication regulations across the United States, knowledge of Canadian regulations an asset

Advanced verbal and written communication skills to effectively communicate with internal and external customers/partners and vendors.

Strong analytical skills for research, review and assessment of claims.

Job Requirements (Education, Experience, Knowledge, Skills And Proficiencies)

You will have adjudication knowledge and experience

Create a white glove customer experience for our Claimants

Manage ongoing claims by requesting further medical, financial documentation or investigations as required and consult with specialists in all areas.

Make decisions on claim benefit eligibility determination and communication decisions to stakeholders

University degree in any discipline or equivalent work experience.

Be responsible for other duties as may be assigned from time to time by Management

Verify data entry for accuracy and completeness

Perform data entry of claims sent to dental consultant is added and confirmed on a spreadsheet

Analytical skills to research review and assess claims

Strong verbal and written communication skills

Strong attention to detail with exceptional organization skills

Review short term disability applications to determine initial eligibility and entitlement to benefits based on medical and contractual requirements

Oversee case until return to work or refer claim internally for case management

Minimum two years experience in a medical, benefits administration, or claims setting; and

Assess functional abilities to determine work-readiness and coordinate suitable return to work

Strong assessment and decision-making skills

Ability to effectively manage and resolve conflict

Strong analytical, organization and time management skills

Manage the day-to-day operations of the Accident Benefits team to achieve essential business goals

Provide effective leadership, coaching and mentoring, performance management, continuous learning, and career development for claims professionals.

Minimum of 5 years’ experience of disability Accident Benefits claims handling

Oversee recruitment/talent requirements and business needs

Minimum of 10 years of claims leadership experience required

Knowledge in life insurance and experience in life and disability claims management would be an asset.

Experience related to disability claims management is preferred.

Plan, implement and evaluate sound case management principles.

Knowledge of the insurance benefit industry is considered an asset.

Must possess excellent knowledge and experience with Microsoft Word, Access, Excel, and PowerPoint.

Experience or knowledge with Fineos is an asset.

Familiarization with the requirements of the appropriate provincial/state legislation and/or regulations related to the type of claim being reviewed.

Perform all necessary benefit calculations and ensure all related activities are in compliance with provincial/state statutory and internal standards.

5 – 7 years experience adjudicating complex claims, including contestable claims;

Knowledge of the interpretation and application of claims adjudication regulations across the United States, knowledge of Canadian regulations an asset

Advanced verbal and written communication skills to effectively communicate with internal and external customers/partners and vendors.

Strong analytical skills for research, review and assessment of claims.

At least 5-7 years of Accident Benefit claims handling experience including experience handling complex and catastrophic files.

Experienced in negotiations and demonstrated experience with independently settling Complex Accident Benefit files;

Handle a pending of Accident Benefit files while receiving regular intake of Complex and Catastrophic claims

Knowledge of provincial legislation governing auto insurance, with ancillary legislation and knowledge of the Dispute Resolution Practice Code.

Excellent communication and interpersonal skills with all levels of staff.

An extensive flex pension and benefits package, with access to virtual healthcare

Apply strong organizational and time management skills to handle a high volume of claims

Review medical documentation and other evidence to determine the eligibility of workers for compensation benefits

Support people recovering from physical injuries by arranging benefit payments and appropriate treatment

Exhibit excellent interpersonal skills and a high level of professionalism to provide empathic, tactful, respectful, and courteous service

Manage emotionally sensitive conversations while demonstrating a high level of personal resiliency

A minimum of 18 months of experience in making adjudicative decisions and/or applying law and/or policy in the last 5 years

Perform other duties as may be assigned from time to time by Management

Verify data entry for accuracy and completeness

Conduct data entry of claims sent to dental consultant is added and confirmed on a spreadsheet

Knowledge of and the ability to interpret dental codes

Analytical skills to research review and assess claims

Strong verbal and written communication skills

Must have a minimum of 3+ years of Accident Benefit claims handling experience

Understanding of basic limit claims handling with a thorough knowledge of the Statutory Accident Benefits Schedule (SABS )

Handle a pending of Accident Benefit files while receiving regular intake of moderate to complex basic claims

Knowledge of provincial legislation governing auto insurance, with ancillary legislation.

Excellent communication and interpersonal skills with all levels of staff.

An extensive flex pension and benefits package, with access to virtual healthcare