Claims Adjudicator I (Medical Conditions and Terminology)

Compunnel Inc.; Quebec; On-site; CAD 45,000 - 60,000; Full time

Job summary

A leading company is seeking a Claims Adjudicator I to manage claims processes, ensuring accuracy and customer service. The role requires bilingual proficiency in French and English, strong communication skills, and attention to detail. The ideal candidate will handle sensitive information and work collaboratively within a team to meet service standards.

Qualifications

• Bilingual in French and English is a must.
• High school diploma required; post-secondary preferred.

Responsibilities

• Organize claim system, conduct intake calls, and update claims tasks.
• Review claims for coverage eligibility and communicate with claimants.
• Prepare written correspondence and manage sensitive information.

Skills

Bilingual

Communication

Analytical Mindset

Detail-oriented

Education

High school diploma

Post-secondary education

Tools

Microsoft Office 365

Job description

Claims Adjudicator I (Medical Conditions and Terminology)

Direct message the job poster from Compunnel Inc.

Job Description

The main function of a claims adjudicator is to obtain information from insured or designated persons for the purpose of settling claims with the insurance carrier.

Typical Day in Role

• Organize and work within claim system to access client information, conduct initial intake calls with claimants, update claims tasks, review simple forms, and submit medical requests.
• Prepare and review insurance claim forms and related documents for completeness.
• Provide customer service, including giving instructions on claims procedures or referrals to other facilities or contractors.
• Review claims to determine initial coverage eligibility and communicate with claimants.
• Summarize employment and mortgage lender documents.
• Prepare all written correspondence, including requests for additional information and decisions.
• Work with the manager to meet objectives and service standards.
• Perform other duties as assigned, including reporting and supporting tasks.

Candidate Requirements/Must Have Skills

• Fully bilingual in French and English.
• Exceptional communication skills, both verbal and written.
• Proficiency in Microsoft Office 365.
• Detail-oriented with quick assessment skills and analytical mindset.
• Ability to handle sensitive and confidential information.

Soft Skills

• Excellent interpersonal and communication skills.
• Decisive and constructive response in high-pressure situations.
• Professionalism that reflects positively to customers.
• Ability to work independently and in a team.
• Strong time management and organizational skills.

Nice-To-Have Skills

• Experience in adjudicating Life and/or Disability claims.
• Knowledge of medical conditions and terminology.

Education

High school diploma or GED required; post-secondary education or equivalent work experience preferred.