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
Robust 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

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📌 Claims Examiner (British Columbia)
🏢 TuGo
📍 British Columbia