Bilingual Claims Examiner

Randstad Canada; Winnipeg; Hybrid; CAD 40,000 - 55,000; Full time

Benefits offered by this job

Hybrid work model

In-office Winnipeg 2 days/week

Contract up to 12 months

Career advancement opportunities

Potential for permanent position

Job summary

Randstad Canada is seeking a Claims Examiner to join a dynamic team in Winnipeg, MB. This full-time, contract up to 12 months position requires bilingual English and French skills and strong customer service background.

You'll review claims, contact sponsors and members within 24 hours, and draft denial letters while escalating complex cases to the Disability Case Manager. A hybrid work model applies, with initial on-site presence in Winnipeg.

Qualifications

• Minimum of one year of experience in a customer service environment.
• Excellent oral and written communication in both French and English.
• Ability to understand complex instructions and basic contractual language.
• Basic knowledge of medical terminology.
• Excellent typing and data entry; proficiency in Microsoft Office programs.
• Experience working in the disability insurance field is an asset.

Responsibilities

• Review the system, claim documents, and contracts to confirm if eligibility requirements are met.
• Responsible for follow-up calls to plan sponsors and plan members within 24 hours of receiving initial claim information.
• Communicate via telephone or email with plan sponsors or members to verify any inconsistencies or missing/inaccurate information.
• Draft denial letters intended for plan sponsors and affected members.
• Assess and manage claims with a predetermined limited duration (Quick Pay).
• Escalate files: transfer to Disability Case Manager (DCM) for assessment and to DCAs for benefit calculations when needed.
• File and organize documents accordingly.

Skills

Bilingual English/French

Customer service

Data entry

Telephone etiquette

Microsoft Office

Tools

Microsoft Office

Job description

Are you passionate about helping people? Do you enjoy solving problems and finding creative solutions? Do you have excellent communication skills in both English and French?

If you answered yes to these questions, we are looking for someone like you to join a dynamic team!

Position: Claims Examiner – Full-time, contract up to 12 months, with possibility of permanency.

Start Date: Immediate / As soon as possible.

Hours: Monday to Friday (flexibility required to work an 8-hour shift during this period).

Work Mode: Hybrid – 2 days per week in-office – Winnipeg, MB.

Advantages

• Full-time position: 37.5 hours per week; full-time on-site initially, with the possibility of a hybrid model based on performance/skills
• Contract duration: Up to 12 months - Location: Winnipeg, MB - Career advancement opportunities
• Potential for a permanent position - Be part of an exceptional team!

Responsibilities

• Review the system, claim documents, and contracts to confirm if eligibility requirements are met.
• Responsible for follow-up calls to plan sponsors and plan members within 24 hours of receiving initial claim information.
• Communicate via telephone or email with plan sponsors or members to verify any inconsistencies or missing/inaccurate information.
• Draft denial letters intended for plan sponsors and affected members.
• Assess and manage claims with a predetermined limited duration (known as "Quick Pay" claims).
• Escalate files: If a claim does not meet "Quick Pay" eligibility criteria, transfer the file to the Disability Case Manager (DCM) for assessment and management, and to DCAs (Disability Claims Assistants) for benefit calculations.
• File and organize documents accordingly.

Qualifications

• Minimum of one year of experience in a customer service environment.
• Excellent oral and written communication skills in both French and English (considered a strong asset).
• Ability to understand complex instructions and basic contractual language.
• Basic knowledge of medical terminology.
• Excellent typing and data entry skills; proficiency in Microsoft Office programs.
• Demonstrated excellence in telephone etiquette and customer service.
• Strong organizational and time management skills, with the ability to manage multiple priorities effectively.
• Experience working in the disability insurance field is considered an asset.

Please note: This position is conditional upon obtaining a reliability status security clearance.

Randstad Canada is committed to fostering a workforce reflective of all peoples of Canada. As a result, we are committed to developing and implementing strategies to increase the equity, diversity and inclusion within the workplace by examining our internal policies, practices, and systems throughout the entire lifecycle of our workforce, including its recruitment, retention and advancement for all employees. In addition to our deep commitment to respecting human rights, we are dedicated to positive actions to affect change to ensure everyone has full participation in the workforce free from any barriers, systemic or otherwise, especially equity-seeking groups who are usually underrepresented in Canada's workforce, including those who identify as women or non-binary/gender non-conforming; Indigenous or Aboriginal Peoples; persons with disabilities (visible or invisible) and; members of visible minorities, racialized groups and the LGBTQ2+ community.

Randstad Canada is committed to creating and maintaining an inclusive and accessible workplace for all its candidates and employees by supporting their accessibility and accommodation needs throughout the employment lifecycle. We ask that all job applications please identify any accommodation requirements by sending an email to [e-mail] to ensure their ability to fully participate in the interview process.