Health Insurance Claims Agent

Jobtailor; Longueuil; On-site; CAD 50,000 - 65,000; Full time

Job summary

Jobtailor is seeking a detail-oriented Health Insurance Claims Analyst in Quebec. You will review and analyze health insurance benefit claims, applying contractual provisions and medical evidence to determine eligibility and payments.

Fluent in French and English, you will communicate decisions in writing and assist insured individuals and beneficiaries. The role requires a DEC and strong data processing skills, with proficiency in computer systems to update records and process payments

Qualifications

• DEC in a relevant field (required).
• Advanced French (spoken and written).
• Advanced English (spoken and written).

Responsibilities

• Review and analyze health insurance benefit claims.
• Analyze files considering contracts, medical evidence, government programs, and internal policies.
• Communicate decisions or recommendations in writing regarding approvals, requests for information, or denials.
• Provide customer service to insured individuals, policyholders, and beneficiaries.
• Update data and process payments using computer systems per contracts and guidelines.

Skills

Health Insurance Claims

Bilingual Communication

Data Processing

Customer Service

File Management

Education

DEC in relevant field

Tools

Computer Systems

Job description

• Review, process, and analyze health insurance benefit claims for specialized products
• Analyze information contained in assigned files, taking into account contractual provisions, medical and/or death-related evidence, government programs, and internal policies and procedures
• Communicate decisions or recommendations primarily in writing regarding benefit approval, requests for additional information, or claim denials
• Provide customer service to insured individuals, policyholders, and/or beneficiaries
• Obtain specific information, communicate claim-related information, and respond to calls
• Perform technical tasks to support the management of assigned files
• Use relevant computer systems to update data and process payments in accordance with contracts and internal guidelines

Requirements

• Hold a college diploma (DEC) in a relevant field
• Advanced proficiency in French, both spoken and written
• Advanced proficiency in English, both spoken and written

Core Competencies

Demonstrates expertise in analyzing health insurance benefit claims, ensuring compliance with contractual provisions and internal policies. Proficient in both French and English, facilitating effective communication with insured individuals and stakeholders.

Highest-signal resume keywords

• Health Insurance Claims Analysis
• Contractual Provisions Review
• Bilingual Communication
• Customer Service
• Data Processing

ATS Optimization Keywords

Hard Skills

• Claims Processing
• File Management
• Technical Analysis
• Data Updating
• Payment Processing

Soft Skills

• Written Communication
• Customer Interaction

Certifications & Qualifications

• College Diploma (DEC)

Industry Keywords

• Health Insurance
• Benefit Claims
• Government Programs
• Internal Policies
• Medical Evidence

Tools & Technologies

• Computer Systems