You process claim files according to company policies and procedures. This involves reviewing claims, recommending payment or denial, or requesting additional information. You process approved payments and/or denials for travellers and providers and set up payment requests from other insurers. Specifically, you will:
- Process claims according to company policies and procedures. This involves reviewing claims for completeness and compliance with policy coverage and recommending acceptance or denial of claim and expenses.
- If claim requires additional supporting documentation to confirm payability, request and review medical history, medical records, itemized bill, etc. following established SOPs.
- Process payments and/or denials to travellers and/or providers.
- Set up requests for payment from provincial medical plans, extended health plans, and any other insurers.
- Assist Customer Service Team by providing claim information to help resolve travellers’ phone and email inquiries.
- Achieve performance targets.
- Collaborate and communicate effectively with team members and all other teams.
- Responsively and effectively handle issues.
- Look for ways to improve customer experience.
- Promote and model TuGo culture, values, and brand promise.
- Continuously build professional and technical expertise.
- Other duties as required.
What you'll bring
- Degree or Diploma in a business-related discipline
- Successful completion of Level 2 Insurance Adjuster’s license or Level 1 General Insurance License is required within 12 months of start date
- Ability to learn and apply knowledge of policy wordings to accurately process claims
- Strong analytical, problem solving and decision-making skills, detail-oriented and well organized
- Excellent communication/customer service skills, particularly by phone and email
- Excellent written and verbal communication skills
- Fluency in French preferred or an additional language such as Spanish, Mandarin or Cantonese is an asset
- Previous experience assessing claims is an asset
- Experience in customer service is an asset
- Ability to multi-task
- Strong interpersonal, and conflict resolution skills
- Knowledge of medical terminology an asset
- Criminal record check is a requirement of the position as required by insurance councils for licensing
- Strong team player and positive contributor
- Proficient in MS Office Suite and able to learn applications quickly
- Able to consistently live our values of valued, effective and trusted
- A strong customer experience focus
- A passion for continuous learning and qualified achievement
📌 Claims Examiner (Richmond)
🏢 TuGo
📍 Richmond
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