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 workplace 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 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

📌 Claims Examiner (Toronto)
🏢 Profit Executive Search
📍 Toronto