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 robust time management skills, claims experience, and policy interpretation.
Responsibilities Process travel insurance claims for medical, trip cancellation/interruption, baggage, dental and vision claims up to the designated limit
Adjudicate claims according to various benefit policies
Handle both inbound and outbound calls, complaints, provide excellent customer service for claims matters both in person and via written correspondence
Work closely with claimants, providers, agents, brokers,
other insurance carriers or their representatives
Work closely with other departments within the company on a day-to-day basis
Maintain accurate documentation on all claim files
Adjust reserves in accordance with the insurer’s guidelines
Present cases and participate in discussions during file reviews and appeals
Ensure all work complies with the PIPEDA and HIPAA
Support department initiatives and objectives
Provide guidance and mentorship to peers
Other related duties as assigned
Qualifications and Education Requirements High school diploma or University Degree or equivalent
Minimum 2-3 years of relevant travel insurance or medical insurance claims processing experience
Bilingual: English/French is required
Strong analytical and problem-solving skills
High level of proficiency in Microsoft Office suites
Superior verbal and written communication skills in English and/or French
Strong time management and organizational skills