Claims Examiner

ProFit Executive Search; Toronto; On-site; CAD 52,000 - 76,000; Full time

Job summary

ProFit Executive Search is seeking an experienced Claims Examiner to handle a large caseload in a fast-paced environment, processing travel and medical insurance claims and communicating decisions to providers, members, and clients. The role requires bilingual English/French, strong analytical and time-management skills, and the ability to navigate multiple policies.

You will work with claims teams and other departments, documenting files and ensuring compliance with privacy regulations.

Qualifications

• High school diploma or University Degree or equivalent.
• Minimum 2-3 years of relevant travel insurance or medical insurance claims processing experience
• Bilingual: English/French is required
• Strong analytical and problem-solving skills
• High level of proficiency in Microsoft Office suites
• Superior verbal and written communication skills in English and/or French
• Strong time management and organizational skills

Responsibilities

• Process travel insurance claims for medical, trip cancellation/interruption, baggage, dental and vision claims up to the designated limit
• Adjudicate claims according to various benefit policies
• Handle both inbound and outbound calls, complaints, provide excellent customer service for claims matters both in person and via written correspondence
• Work closely with claimants, providers, agents, brokers, other insurance carriers or their representatives
• Work closely with other departments within the company on a day-to-day basis
• Maintain accurate documentation on all claim files
• Adjust reserves in accordance with the insurer’s guidelines
• Present cases and participate in discussions during file reviews and appeals
• Ensure all work complies with the PIPEDA and HIPAA
• Support department initiatives and objectives
• Provide guidance and mentorship to peers
• Other related duties as assigned

Skills

Analytical skills

Problem-solving

Time management

Communication skills

Microsoft Office

Bilingual English/French

Education

High school diploma

University degree or equivalent

Tools

Microsoft Office

Job description

You are an experienced Claims Examiner who can handle a large case load, multi-task, and meet tight deadlines. You thrive in a fast-paced environment providing excellent customer service in both the turnaround of the claim and handling emails and incoming calls. You will have the desire to develop an in-depth understanding of this position and be able to easily maneuver through numerous policies to accurately assess claims and inquiries. You are a very strong team player.

The Claims Examiner will be responsible for processing a variety of different claims and communicating these decisions to providers, members, and clients. This role requires strong time management skills, claims experience, and policy interpretation.

Responsibilities

• Process travel insurance claims for medical, trip cancellation/interruption, baggage, dental and vision claims up to the designated limit
• Adjudicate claims according to various benefit policies
• Handle both inbound and outbound calls, complaints, provide excellent customer service for claims matters both in person and via written correspondence
• Work closely with claimants, providers, agents, brokers, other insurance carriers or their representatives
• Work closely with other departments within the company on a day-to-day basis
• Maintain accurate documentation on all claim files
• Adjust reserves in accordance with the insurer’s guidelines
• Present cases and participate in discussions during file reviews and appeals
• Ensure all work complies with the PIPEDA and HIPAA
• Support department initiatives and objectives
• Provide guidance and mentorship to peers
• Other related duties as assigned

Qualifications and Education Requirements

• High school diploma or University Degree or equivalent
• Minimum 2-3 years of relevant travel insurance or medical insurance claims processing experience
• Bilingual: English/French is required
• Strong analytical and problem-solving skills
• High level of proficiency in Microsoft Office suites
• Superior verbal and written communication skills in English and/or French
• Strong time management and organizational skills