Claims Examiner

AppleOne Employment Services; Toronto; On-site; CAD 34,440 - 37,195; Full time

Job summary

A recruitment agency in Toronto is seeking an experienced Claims Examiner to join a growing team. The ideal candidate will have experience in travel or medical insurance claims and excellent customer service skills. Responsibilities include reviewing and adjudicating claims and maintaining compliance with regulations. The position offers $25-27/hr for a 6-month temporary role with the potential to go permanent.

Qualifications

• Must have 2-3 years of experience in travel or medical insurance claims processing.
• Proficient in analytical skills and problem-solving.

Responsibilities

• Review, assess, and adjudicate travel insurance claims.
• Deliver exceptional customer service through communication.
• Ensure compliance with privacy regulations.

Skills

Strong analytical skills

Excellent verbal communication

Problem-solving abilities

Organizational skills

Education

High school diploma or post-secondary education

Tools

Microsoft Office Suite

Job description

AppleOne Employment Services Provided Pay Range

This range is provided by AppleOne Employment Services. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base Pay Range

$25.00/hr - $27.00/hr

Senior Executive Recruiter | Accounting Advantage/HROne/Pro Fit Executive Search (Appleone Group of Companies)

$25-27ph 6 month temp with potential to go permanent

Our client is seeking an experienced Claims Examiner to join their growing team.

If you have hands‑on experience in claims adjudication, especially within travel or medical insurance, and you’re passionate about delivering exceptional customer service, we’d love to hear from you.

About the Role

As a Claims Examiner, you will be responsible for reviewing, assessing, and adjudicating a variety of travel insurance claims. You will work closely with claimants, providers, industry partners, and internal teams to ensure timely, accurate, and fair claim resolutions all while maintaining compliance with regulatory standards and upholding high service expectations.

Key Responsibilities

• Process travel insurance claims (medical, trip cancellation/interruption, baggage, dental, vision) within designated approval limits
• Adjudicate claims in alignment with applicable benefit policies and coverage guidelines
• Handle inbound/outbound calls and written correspondence, delivering exceptional customer service
• Collaborate with claimants, providers, agents/brokers, and other insurance carriers
• Work cross‑functionally with internal departments to support daily operations
• Maintain thorough claim file documentation and adjust reserves in accordance with insurer standards
• Participate in file reviews, appeal discussions, and case presentations
• Ensure compliance with privacy regulations including PIPEDA and HIPAA
• Mentor team members and support departmental projects and initiatives

Required Qualifications

• High school diploma or post‑secondary education
• 2–3 years of experience in travel or medical insurance claims processing preferred
• Strong analytical and problem‑solving skills
• Proficiency in Microsoft Office Suite
• Excellent verbal and written communication abilities
• Effective time management and strong organizational skills

Preferred Experience

• Background in snowbird, expatriate insurance, or third‑party administration (TPA)
• Experience handling Canadian and U.S. medical invoices/claims
• Knowledge of dispute resolution processes
• Familiarity with GHIP recovery, coordination of benefits, or subrogation

Disclaimer

This is currently for an active job opportunity.

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