Claims Examiner

National Healthcare Solutions, Inc.; Markham; Hybrid; CAD 40,000 - 45,000; Full time

Benefits offered by this job

Dental care

Employee assistance program

Extended health care

Life insurance

On-site parking

Paid time off

RRSP match

Job summary

Epic Health Solutions is seeking a detail-oriented, bilingual Claims Examiner to join our Travel Insurance team in Markham, Ontario. You will review, investigate, and adjudicate travel insurance claims while communicating professionally with insureds, brokers, and medical facilities in English and Portuguese.

This role emphasizes accuracy, timely claim decisions, and collaboration within a fast-paced environment.

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 read, write, and speak with agents, medical facilities, and brokers in both languages.
• Strong understanding of travel insurance policies and benefits is a plus.
• 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.

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

Skills

Bilingual English-Portuguese

Analytical skills

Attention to detail

Written and verbal communication

MS Office proficiency

Tools

MS Office

Job description

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 benefits 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 [e-mail] and we will work with you to meet your needs.