About this position
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 health, dental and vision claims up to the designated limit
- Adjudicate claims according to various benefit policies
- Provide excellent customer service for claims matters both in person and via written correspondence
- Handle both inbound and outbound calls to members and health providers as required
- Work closely with both the Assistance and Finance departments, as well as other departments on a day-to-day basis
- Ensure all work complies with the PIPEDA and HIPAA
- Support department initiatives that increase revenues, save costs, and meet company objectives
- Maintain concise file documentation consistent with corporate policies
- Adjust reserves to ensure that reserve activities are consistent with corporate policies
- Provide overall portfolio management of assigned claims files
- Develop action plans and report claim progression on a regular basis
- Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures
- Present cases and participate in discussions during department meetings
- Provide guidance and mentorship to peers
- Participate in client implementations and projects where required
- Other related duties as assigned
Qualifications and Education Requirements
- High school diploma or equivalent
- Experience in the travel insurance industry is required
- Minimum 2-3 years of relevant Canadian claims processing experience
- Experience in processing health, dental, and vision claims
- High level of proficiency in Microsoft Office suites, specifically Excel
- Superior verbal and written communication skills
- Strong time management and organizational skills
- Strong analytical and problem-solving skills
Preferred Skills
- Snowbird, expatriate insurance, TPA experience
- Cost containment/provider relations experience
- Experience with medical coding standards
- Dispute resolutions experience
- GHIP recovery/coordination of benefits/subrogation
- Experience in handling US medical invoices/claims