Claims Review Specialist Jobs

Solid experience dealing with change management control.

Leads the change management process and contract close-out plan that minimizes the time necessary to achieve Substantial Completion of contracts.

Accredited degree or equivalent in Business, Construction Management, or Business Law

7 years of contract management and claims administration within the construction industry

Developing and implementing, in close coordination with the Contract Manager, contract

Experience in accurately formulating multiple compensation structures including, but not limited to, reimbursable cost, lump sum, and unit price

Atleast 3 year(s) of retail and/or merchandising experience with exposure to assortment planning, store operations, project management and/or communications

University or College degree, preferably in in business, retail management or communications

Possess a sound understanding of Retail Operations, preferably in the areas of Category Management, Retail Merchandising and/or Supply Chain

Working Knowledge of VBA and SQL is an asset.

Intermediate to advanced Excel and Word skills specifically use of pivot tables and V lookups

Ability to work with and influence cross functional groups and teams

Deliver on all key performance indicators as it relates to loss development, claims leakage control and expense management

Appropriate knowledge of all relevant regulatory and legal requirements applicable to the position

A skilled communicator allowing you to foster favorable business relationships and provide clear guidance to clients and stakeholders, internal and external

3+ years of liability claims experience (including direct handling of E&O/D&O claims would be an asset).

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

Assessing coverage under the respective policies and communicating coverage positions or issues with underwriters and other internal stakeholders, brokers and insureds

Knowledge of Applied Systems EPIC Broker Management System an asset

Claims intake, reporting, file management

Work closely with account teams and clients to ensure exceptional client management.

Post secondary education, preferably in business administration or related field

4+ years of commercial insurance experience in a property and casualty or liability claims function

Experience in construction insurance an asset

Obtained or working toward Chartered Insurance Professional (CIP) or Canadian Risk Management (CRM) designation preferred.

Utilizing experience and information obtained to evaluate financial exposures. Negotiating appropriate and timely resolutions on assigned claims across multiple jurisdictions.

Moderate to Extensive years of experience in handling litigation claims for Professional lines of business.

Robust analytical and organizational skills, with the proven ability to work independently while demonstrating initiative toward continuous improvement.

Enhanced family friendly leave benefits

Signatory to the UK Women in Finance Charter

Ability to provide an expeditious and delightful member experience

At least one year of experience providing customer service over the phone

French bilingual skills are a plus!

Review medical records to make claim outcome decisions against received invoice(s) as aligned with the Trupanion policy

Enter data from medical records into the database

Contact members regarding claim assessment and status (phone/email) as applicable

Ability to provide an expeditious and delightful member experience

At least one year of experience providing customer service over the phone

French bilingual skills are a plus!

Review medical records to make claim outcome decisions against received invoice(s) as aligned with the Trupanion policy

Enter data from medical records into the database

Contact members regarding claim assessment and status (phone/email) as applicable

Minimum of 3 years customer care experience (insurance, and health and dental benefits claims an asset)

Strong communication skills, both verbal and written

Claims adjudication and customer care experience.

Technical knowledge on application base system

A desire to provide exceptional customer service, and a valuable experience to clients.

Extended health care and dental benefits

You have 2+ years residential underwriting and/or audit or Quality Control/Quality Assurance and/or Loan review experience in the residential mortgage industry

You have strong problem-solving skills and the ability to proactively identify risks, and recommend solutions

You have strong communication skills, written and verbal

You’re ensuring each file complies with the underwriting standards and guidelines prior to funding

You’re performing a pre-funding review/audit of files and providing approval for funding, or providing observations or findings to the Underwriters

You’re addressing and overseeing the appropriate corrections of any errors

Coordinate and provide instruction and/or training of regulatory requirements for compliance

Mentor and develop team members through the sharing of knowledge and best practices

Coaching adjusters through large loss forms and proper presentation skills

Minimum of seven years Property and Casualty industry experience

Perform ongoing research and analysis of industry and competitive market trends to support process improvement

Liaise with the Executive Office, assisting with the development of rules, guidelines, manuals and forms

You’ll have full control over your schedule. We value trust, autonomy, goals, and elevating each other, not micromanagement.

Document your findings and make them applicable to Eli’s user experience and business model.

Work with the Quality Assurance and Regulatory Affairs Manager to see how your findings fit into the regulatory strategy.

You have experience in reviewing scientific literature and using tools such as Pubmed, sci-hub, and Google Scholar.

Consult with Eli’s medical advisors to validate the relevance of your research findings to the clinical setting.

Gain a deep understanding of our users by participating in customer validation calls and reviewing customer research.

Proven leadership and time management skills in a team environment

Ability to manage a pending and multi-task, strong organizational and time management skills.

Responsible for data integrity and the appropriate documentation of the claim’s file as well as for compliance with regulatory notification requirements.

Manage expenses by working within vendor approved networks and managing scope of work assigned to outside vendors.

Ensure legal compliance by following provincial, federal laws and regulations and internal control requirements.

Good knowledge of insurance claims, knowledge of the vehicle repair process and of the legislation and regulations governing automobile insurance.

Reviews contracted partner staffing reports and other documentation as required to confirm:

Required submitted reports accurately reflect staffing patterns

Staffing models and mix meet IH contract service deliverables

Staffing models and mix meet Ministry of Health (MoH) guidelines and standards

Staffing models and mix appropriately meet identified resident needs

Supports the Long-term Care Services team by participating in meetings and committees as required.

Commercial Account Management, Relationship Management or Commercial Adjudication experience

Engage in cross skilling, training and role hybridization activities to ensure continuous learning and an innovative workforce

Commercial lending or credit experience

Strong experience in analyzing company financial statements

Effective communication and negotiation skills

Capacity to manage work volumes to meet deadlines

Post-secondary degree/diploma or equivalent work experience

Minimum 2 years related work experience in audit/quality/fraud/clinic setting

Experience within a paramedical or other clinic setting considered an asset

Excellent communication skills, both written and oral

Ability to manage multiple demands with tight deadlines is necessary.

Understanding of Health Claims processes and business knowledge would be an asset.

Post-secondary degree/diploma or equivalent work experience

Minimum 2 years related work experience in audit/quality/fraud/clinic setting

Experience within a paramedical or other clinic setting considered an asset

Excellent communication skills, both written and oral

Ability to manage multiple demands with tight deadlines is necessary.

Understanding of Health Claims processes and business knowledge would be an asset.

Strong multi-tasking, time-management, customer service, and organizational skills

Manage accident claims process from conception to completion

Take action to manage own personal development; work towards CIP designation

Minimum 3 years verifiable experience in Claims, Safety & Compliance or a related field

Previous experience in commercial trucking industry is preferred

Strong oral and written communication skills via telephone, email, and in person

Education or work experience in an audit/quality/fraud discipline considered an asset

Post-secondary degree/diploma or equivalent work experience

Experience within a paramedical or other clinic setting considered an asset

Excellent communication skills, both written and oral

Ability to manage multiple demands with tight deadlines is necessary.

Understanding of Health Claims processes and business knowledge would be an asset.