Claims Examiner

MSH Americas - Diot-Siaci Group; Toronto; Hybrid; CAD 48,000 - 52,000; Full time

Benefits offered by this job

Salary 48-52k CAD annually

Flexible hybrid work setup

Employee assistance program

Wellness spending account

RRSP matching

3 weeks vacation

Growth opportunities

Inclusive culture

Leadership support

Job summary

MSH Americas - Diot-Siaci Group is seeking an experienced Claims Examiner who can manage a large caseload, multi-task and meet tight deadlines. You will process travel insurance and medical claims, adjudicate per policy, and communicate decisions to providers, members, and clients.

You must be bilingual (English/French), have strong time management and analytical skills, and be proficient with Microsoft Office.

Qualifications

• You have 2-3 years of travel or medical insurance claims processing experience.
• You communicate clearly in English and French and document decisions accurately.
• You handle a fast-paced caseload with strong time management and multitasking.

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 inbound/outbound calls and correspondence with excellent customer service.
• Collaborate with claimants, providers, agents, brokers, and other carriers.
• Maintain documentation on all claim files and adjust reserves per guidelines.
• Present cases during file reviews and appeals.
• Ensure compliance with PIPEDA and HIPAA.
• Mentor peers and support departmental initiatives.

Skills

Bilingual English/French

Analytical skills

Problem solving

Microsoft Office

Verbal & written communication

Time management

Organizational skills

Education

High school diploma or University Degree or equivalent

Job description

At MSH, passion meets profession. We're a team of dedicated enthusiasts who find genuine fulfillment in what we do — and we're looking for someone who feels the same way.

About You

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 claim turnaround 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 assess claims and inquiries accurately. You are a strong team player.

You will be responsible for processing a variety of different claims and communicating these decisions to providers, members, and clients. You have strong time management skills, claims experience, and policy interpretation.

In This Role, You’ll Get To Experience

• 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, and complaints, and 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 following 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

What You Bring

• 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
• Must successfully apply for Alberta Adjuster License within one month of hire

What do you need to succeed?

• Experience in handling Canadian and US medical invoices/claims
• Dispute resolutions experience
• GHIP recovery/coordination of benefits/subrogation
• Solid Team Player

What's In It for You

• Salary Range: 48-52k CAD annually + Variable Bonus (Final compensation will reflect the candidate's experience, skills, and qualifications)
• Flexible hybrid work setup
• Employee assistance program
• Wellness spending account
• RRSP matching
• Minimum 3 weeks vacation (plus generous sick and flex days)
• Real opportunities for growth and skill development
• Inclusive, diverse workplace culture
• Leadership that genuinely cares about your success and well-being
• Clear paths for both vertical and horizontal career growth

MSH is an equal opportunity employer committed to fostering an inclusive, barrier‑free recruitment process. We welcome applications from all qualified individuals regardless of race, ancestry, colour, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity or expression, age, record of offences, marital status, family status, or disability.

If you require accommodation at any stage of the recruitment process, please reach out. We will work with you in accordance with the Ontario Human Rights Code and the Accessibility for Ontarians with Disabilities Act (AODA).

We thank all applicants for their interest. Only those selected for an interview will be contacted.

In accordance with Ontario's Working for Workers Four Act, 2024, MSH confirms that artificial intelligence tools may be used in the recruitment and selection process for this position