Claims Case Manager

Assomption; City of Moncton; Hybrid; CAD 55,000 - 75,000; Full time

Benefits offered by this job

Benefits package

Downtown Moncton

Volunteer day

Family care leave

Pet care leave

Job summary

Assomption seeks an experienced claims specialist to analyze and adjudicate lower to moderate complexity insurance claims, including death and critical illness. You will review medical information, evaluate contracts, and draft recommendations for clients and stakeholders.

Responsibilities include guiding agents and clients, handling inquiries, and contributing to process improvements within SharePoint-backed tools. The role emphasizes autonomy and team collaboration in a dynamic Moncton setting.

Qualifications

• Post-secondary diploma in health sciences or related field (or equivalent experience).
• Excellent knowledge of medical terminology and provincial healthcare systems.
• Bilingual French and English with strong verbal and written communication.
• Understanding of provincial legislation for claims adjudication.
• Ability to interpret various individual insurance contracts and products.
• Familiarity with claims processing computer systems.
• Knowledge of SharePoint and internal procedures.
• Strong analytical skills and sound judgment.
• Autonomy and teamwork ability.

Responsibilities

• Analyze insurance claims, including review of contestable and non-contestable claims, evaluate medical information, formulate recommendations and communicate with clients and stakeholders.
• Provide guidance to agents, clients, and internal departments; respond to inquiries related to policies and claims.
• Participate in projects and continuous improvement initiatives; contribute to forms development and maintenance of reference tools in SharePoint.

Skills

Bilingual French/English

Analytical skills

Autonomy

Teamwork

Medical terminology

Claims processing systems

SharePoint

Education

Diploma in health sciences or related field

Tools

SharePoint

Claims processing software

Job description

The incumbent is responsible for analyzing, assessing, investigating, and making decisions on lower to moderate complexity individual insurance claims, including death and critical illness claims, within established monetary and approval authority limits. The incumbent reviews claims with diligence and attention to detail to meet established service standards, maintain high quality standards, and deliver exceptional customer service.

Qualifications

To be successful in this role, the incumbent should possess:

• A post-secondary diploma in health sciences or a related field (or equivalent experience in disability management).
• Excellent knowledge of medical terminology, as well as a solid understanding of the healthcare systems across the different provinces.
• Excellent verbal and written communication skills in both French and English, including the ability to manage routine communications, complex cases, and complaints.
• A good understanding of provincial legislation applicable to claims adjudication and administration.
• The ability to interpret various individual insurance contracts and related products.
• Knowledge of the computer systems used in claims processing.
• The ability to follow and apply claims guidelines for various products, as well as internal procedures, including claims requirements, reinsurance treaties, and tools such as SharePoint.
• Strong analytical skills and sound judgment.
• A high degree of autonomy and the ability to work effectively as part of a team.

Responsibilities

• Analyze insurance claims, including the review of contestable and non-contestable claims, the collection and evaluation of medical information, the formulation of recommendations, decision-making, and correspondence with clients, agents, beneficiaries, and internal or external stakeholders.
• Provide support to agents, representatives, other departments, and clients by offering guidance to internal and external stakeholders, responding to inquiries related to policies, case scenarios, and claims, and assisting representatives as required.
• Participate in projects and continuous improvement initiatives within the department by contributing to product-related initiatives, forms development, administrative procedures, and the maintenance of reference tools used by the team.
• Maintain and update procedures in SharePoint to ensure analyst reference tools remain current, accessible, consistent, and aligned with established practices.

Additional Information

• The chance to be part of a dynamic, high-performance team that adheres to the following ethical values: leadership, collaboration, trust and commitment;
• Opportunities for training and development;
• A comprehensive benefits package including competitive salary, bonus, pension and benefits;
• A dynamic downtown Moncton location;
• A paid volunteer day;
• Time off to care for family members and pets.