Life and Living Benefits Claims Adjudicator

Disability Management Institute; Canada; Remote; CAD 65,000 - 75,000; Full time

Job summary

Join a forward-thinking company as a Life and Living Benefits Claims Adjudicator, where you will play a crucial role in managing and adjudicating claims while providing exceptional service to clients. This position offers the opportunity to work remotely in Canada, ensuring that you maintain a healthy work-life balance. You will be responsible for assessing claims, communicating with stakeholders, and ensuring compliance with policy provisions. With a competitive salary range and a comprehensive benefits package, this role is perfect for those looking to grow in a dynamic environment that values professional development and work-life balance.

Benefits

Comprehensive benefits package

Minimum of 3 weeks' vacation

Flex days

Wellness programs

Employee education program

Participation in Happy Friday program

Qualifications

• 5 years of claims experience in a group insurance environment.
• 2 years adjudicating Life and Living Benefit claims, including Critical Illness.
• Familiarity with medical terminology and life insurance contract language.

Responsibilities

• Manage a caseload of Life and Living Benefit claims with proactive communication.
• Interview claimants and assess claims for contractual eligibility.
• Draft written correspondence identifying claim activity and next steps.

Skills

Claims Experience

Adjudicating Life and Living Benefit Claims

Medical Terminology

MS Office Skills

Letter Writing Skills

Analytical Skills

Education

Post Secondary Degree or Diploma

Tools

Excel

Job description

Life and Living Benefits Claims Adjudicator

Disability Management Institute (DMI) offers small and medium sized employers flexible innovative solutions to their disability management needs. Our specialties include: WCB/WSIB Claims Management, Self-Funded Sick Leave Adjudication, and Non Occupational Absence Management, Return to Work Planning, Disability Management, and STD, MTD, and LTD Claims Management.

YOUR ROLE

We are currently looking for a Life & Living Benefits Claims Adjudicator to join our team, working remotely in Canada. As Life & Living Benefits Claims Adjudicator, you will adjudicate Critical Illness, Accident & Serious Illness, Life, Accidental Death & Dismemberment claims within established timeframes and within the scope of the policy while ensuring excellent customer service.

WHAT TO EXPECT

• Identify a raving fan of your work within 30 days
• Manage a caseload of new and ongoing Life and Living Benefit claims.
• Provide proactive communication to Claimants, Beneficiaries, Executors, legal representatives and any appropriate stakeholders to keep them apprised of claim status updates and claim progression
• Ensure service standards are met.
• Apply the appropriate policy provisions when reviewing claims and render a decision.

YOUR IMPACT

• Interview claimants, beneficiaries and employers to gather relevant claim information.
• Ensure all claims are processed in date order, in accordance with the agreed upon service standards for each Client.
• Utilize available resources to assess medical information and policy. Where appropriate, liaise in a professional manner with insurance agencies, doctors, employees, management, lawyers, etc.
• Assess claims for contractual eligibility, as well as determine which applicable plan provisions may apply and proceed to investigate accordingly.
• Draft and deliver written correspondence identifying claim activity and next steps.
• Maintain confidentiality over client and corporate records and medical claims information.
• Calculate and pay approved claims.

THIS IS YOU

• 5 years of claims experience in a group insurance environment
• 2 years of experience adjudicating Life and Living Benefit claims, including Critical Illness, Accident & Serious Illness, Life, Accidental Death & Dismemberment
• Post secondary degree or diploma or equivalent experience.
• Familiarity with medical terminology and Life insurance contract language (specifically surrounding Life and Living benefits products).
• You have strong MS Office skills, with special attention to Excel reporting abilities
• You have the ability to analyze and interpret detailed medical records and other materials to determine eligibility for benefits
• You have excellent letter writing skills, with attention to detail and accuracy

THIS IS NICE

• CEBS, CIP, or LOMA designations
• Medical background

WHAT YOU'LL GET

• Comprehensive and competitive benefits package that supports you
• Our company-wide vacation policy guarantees a minimum of 3 weeks' vacation
• Flex days to help you achieve that work-life balance
• Wellness programs to support you in and out of the office
• Learn and grow with us through our employee education program
• Participation in our Happy Friday program

YOUR COMPENSATION

At the time of this posting, the estimated annual base salary pay range for this position is $65,000-$75,000. Individual compensation within this range is determined by factors such as job-related skills, relevant experience, and education/training.

WHY YOU WILL LOVE WORKING FOR DMI

Professional Development

We are a fast-growing company and as a result, there are ample opportunities for career growth and professional development when you join our team.

Events and Socials

When you join our team, you’ll enjoy everything from virtual company-wide teaching and training days, industry events, Happy Fridays, team social events and much more!

We thank everyone who applies to the Life & Living Benefits Claims Adjudicator opportunity; however, due to the volume of applications we receive, we are only able to contact candidates who have been selected for an interview.