Salary Range: CA$40,000.00 To CA$45,000.00 Annually

Company Overview
Epic Health Solutions boasts over 35 years of experience in the healthcare industry, providing innovative solutions in an ever-evolving marketplace. As part of an award-winning enterprise group, we're proud to support a global team of more than 500 employees dedicated to enhancing healthcare services.

Summary
We are seeking a detail-oriented, bilingual Claims Examiner to join our Travel Insurance team at Epic Health Solutions. In this role, you will review, investigate, and adjudicate travel insurance claims while communicating professionally with insureds, brokers, and medical facilities in both English and Portuguese. This position is essential to maintaining claims accuracy and supporting our operational goals.

Key Responsibilities
Review, investigate, and adjudicate Travel Insurance claims (Medical, Trip Cancellation/Interruption/Delay, Baggage Loss/Damage/Delay) in accordance with policy terms and conditions
Communicate effectively and professionally in both English and Portuguese with insureds, agents/brokers, medical facilities, and other stakeholders to collect documentation and explain claim status and decisions
Analyze medical records and other supporting evidence to determine coverage and validity of claims
Respond to claim inquiries and complaints from insureds and brokers in a timely, courteous manner
Maintain accurate reserves and ensure timely updates to the claims management system
Draft clear, accurate, and compliant claim denial letters that cite applicable policy language, in both English and Portuguese as needed
Participate in quality reviews, training,



and continuous improvement initiatives
Perform other duties as assigned

Qualifications
2-3 years of experience in claims examining or adjusting insurance claims (Travel, Health, or related field)
Bilingual fluency in English and Portuguese (spoken and written) required; must be able to professionally read, write, and speak with agents, medical facilities, and brokers in both languages
Strong understanding of travel insurance policies and perks considered an asset
Excellent analytical, problem-solving, and decision-making skills
Strong attention to detail and accuracy
Strong written and verbal communication skills
Ability to prioritize tasks and manage deadlines in a fast-paced environment
Proficiency with MS Office

Core Competencies
Claims Adjudication · Customer Service Excellence · Accuracy and Attention to Detail · Communication · Time Management · Accountability · Problem Solving · Teamwork · Professionalism

Job Type

Full-time

Expected Hours

Schedule

8-hour shift, Day shift, Monday to Friday

Work Location

Hybrid

Language Requirements

English and Portuguese

Dental care
Employee assistance program
Extended health care
Life insurance
On-site parking
Paid time off
RRSP match

Accessibility
Epic Health Solutions is committed to providing an inclusive and accessible work environment and complies with the Accessibility for Ontarians with Disabilities Act (AODA). We are dedicated to ensuring equal opportunities for all applicants. If you require accommodations during the recruitment process, please email us at [email protected] and we will work with you to meet your needs.

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📌 Claims Examiner (Ontario)
🏢 National Healthcare Solutions
📍 Ontario