- Assess claim eligibility by analyzing contractual, medical, functional, and professional documentation
- Manage an active caseload while meeting service standards, KPIs, and processing timelines
- Thoroughly document claims analyses and maintain accurate records
- Communicate professionally and empathetically to provide updates, clarify claim status, and explain decisions
- Conduct detailed telephone interviews with clients or other stakeholders
- Identify required supporting documentation and perform necessary follow-ups
- Collaborate with the team, plan sponsors, and other partners
- Participate in departmental projects and continuous improvement initiatives
- Identify opportunities to streamline processes and adapt to change
- Perform other related duties as required
Requirements
- Post-secondary education or equivalent work experience; a college diploma (DEC) in a relevant field is an asset
- Professional designations such as FLHC, FLMI, or ALHC are assets
- Minimum of one year of experience in insurance claims processing, particularly in life, disability, and critical illness insurance
- Medical knowledge gained through claims management, underwriting/pricing, or a medical/paramedical profession is an asset
- Robust analytical and problem-solving skills with a high attention to detail
- Excellent command of English
- Excellent command of French to communicate with clients and/or colleagues in Quebec
- Ability to conduct sensitive telephone interviews and communicate decisions with tact
- Proficiency with Microsoft Office (Word, Outlook) and case management software
- Ability to manage multiple priorities simultaneously while meeting competing deadlines
- Professionalism under pressure and ability to handle stressful situations
- Positive attitude, strong team player and adaptability to organizational change
Core Competencies
Demonstrates expertise in insurance claims processing, particularly in life, disability, and critical illness insurance, while effectively managing caseloads and maintaining high service standards. Proficient in conducting sensitive interviews and communicating decisions with professionalism and empathy.