Claims Examiner

1 week ago

Toronto, Canada MSH Americas - Diot-Siaci Group Full time

About Us:

We are seeking ambitious individuals who share our values and our passion for making a positive impact on people's lives around the world. If you are looking for a career that challenges and inspires you, then you've come to the right place.


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?

  • Snowbird, expatriate insurance, TPA experience
  • 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:

  • Hybrid work environment
  • Excellent health benefits
  • Employee assistance program
  • Wellness account
  • RRSP matching
  • Minimum 3 weeks’ vacation
  • Generous allowances for sick and flex days
  • Tuition reimbursement program
  • Opportunities to learn new skills, grow, and move into different roles
  • A work environment that embraces diversity and promotes inclusivity.
  • Supportive leadership prioritizes your success and cares about your well-being.
  • A growth trajectory that is designed to expand both vertically and horizontally, providing you with opportunities to pursue your passions and acquire new skills.


Additional Notes

  • Our work week is Monday to Friday, 8 hours per day. The hours are flexible, with start times between 8 am and 10 am. Occasional flexibility in hours is required to meet the needs of the business.
  • A laptop will be provided


MSH is an Equal Opportunity Employer

MSH Americas is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other protected status under applicable law. We encourage and welcome applicants from all backgrounds to apply for our open positions.

Removing obstacles to offer fair access to jobs is our top priority. When a candidate asks for reasonable accommodation throughout the application process, a Human Resources professional will assist them. The information provided during the accommodation request process will be handled, saved, and utilized in accordance with the laws that apply to it as well as the rules of MSH International.

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