Claims Adjudicator
4 weeks ago
Job Summary( Primary purpose of this Role):The Claims Adjudicator is accountable for handling claims in accordance with high service standardsto meet or surpass client expectations. The Adjudicator is required to make a number of determinations that may affect the member's entitlement to benefits and/or the amount of benefits that are payable. The Adjudicator reviews claims for completeness, enters and assesses claims, and produces the final statement and/or payment responsibility, after the member's insurance benefits are applied to a claim. The Adjudicator will be required to contact various practitioners or service providers to obtain clarification on claim information as necessary. Individual Accountabilities: Claims Adjudication 80%Assesses highly complex health/dental claims in keeping with contract provisions, taking initiative and ensuring that empowered decision making is a key component of the process. Assume ownership of the claims assigned with an understanding of the urgency of specific cases and effectively prioritize work accordingly.Establish and maintain quality customer service within our turnaround times using influence with internal and external clients to meet all pre-established service standards in order to delight our customers.. Supporting the Business 20 % Sound knowledge and ability to apply appropriate risk management tools and techniques.Actively participate in various projects that improve effectiveness and efficiency in claims practices in keeping with our culture of continuous improvement.Manage all issues and requirements related to the claim to achieve customer/claim resolution handing off only as appropriate.(claims adjustments, warranty investigation, technical decisions)Key Shared Accountabilities:Commitment to Financial Efficiency and Continuous Improvement targets, as requiredCommitment to improving NPS (customer) scores based on overall CX goalsCommitment to the achievement of the divisional and organizational “Must Win Battles” Job Requirements : Post-secondary education or equivalent experienceStrong customer service focus and the ability to take the initiativePrevious claims adjudication and/or relevant insurance or health care industry experience a definite asset Strong working knowledge of Microsoft Office 365 suite of programsDetail oriented with quick assessment skills Excellent interpersonal skills and the ability to interact and work with others at all levels to achieve customer resolutionSuperior communication skills (verbal and written) for a variety of internal and external audiences (Both in English and French as applicable)The ability to work effectively as an individual and as part of a team in a fast-paced environment
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Claims Manager, Casualty
4 months ago
Montréal, Canada Northbridge Financial Corporation Full timeWe’re Northbridge Financial. We’re proud to be 100% Canadian and owned by Fairfax Financial. We serve through our Northbridge Insurance, Federated Insurance, and TruShield Insurance brands. We have a reputation for being one of Canada’s leading commercial property and casualty insurance company. Our employees are dedicated to understanding the needs of...
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Claims Analyst
3 months ago
Montréal, Canada Intertape Polymer Group (IPG) Full time**Claims Analyst **Position Purpose**:This position adjudicates all Customer Disputes or Claims in accordance with IPG business guidelines and respective Policies and Procedures. **Principle Accountabilities** - Validate and process customer claims such as returns, shortages, pricing discrepancies in a timely manner - Analyze and review claims file...
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Claims Examiner, Bilingual
4 months ago
Montréal, Canada Canada Life Assurance Company Full time**Job Description**: If you want to be rewarded for individual performance and contributions, Canada Life offers you the opportunity to begin an enriching and challenging career with our Claims Examiner team. You will be supported and rewarded for achieving clear individual and team objectives. As a part of our Claims Examiner team, you will have the...
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Bilingual Disability Claim Processor
3 months ago
Montréal, Canada Canada Life Assurance Company Full time**Job Description**: We are looking for a **_Disability Claims Processor_** Reporting to the DCA Team Manager, the Disability Claims Processor is responsible for the prompt, accurate set-up of all new short-term disability claims, processing the Quick pay claim, including the set up and payment, processing of payments both STD and LTD, responding to...
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Claims Adjuster, Casualty and Litigation
4 months ago
Montréal, Canada Northbridge Financial Corporation Full time**What it’s like to be a Northbridge Claims Adjuster** As a Claims Adjuster you will be part of a dynamic team that prides itself on having a sharp eye on detail while keeping the customer experience top of mind. The Casualty and Litigation team handle a variety of claim across several lines of business, including Auto, CGL, Directors’ and Officers’,...
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Claims Adjuster
3 months ago
Montérégie, QC, Canada Sedgwick Full timeTaking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for...
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Bilingual Claims Examiner
3 months ago
Montréal, Canada Securian Canada Full time**Who we need**What you will do - Accurately examine claim files within the processing guidelines in accordance with the certificate provisions and review the language of the certificate and how to analyze it accurately to each different claim file; - Keep all claim processing accurate and consistent with company guidelines and procedures; - Give a solid...
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Claims Adjuster/expert en Sinistre
1 month ago
Montréal, QC, Canada LGM Financial Services Inc. Full timeExpert en sinistre - Montreal, QC LGM est un fournisseur canadien de premier ordre de garanties automobiles ainsi que de produits financiers et d’assurance. Depuis 1998, LGM, qui fournit des produits de qualité et d'excellentes solutions de formation, est au service de plus de 1 200 concessionnaires automobiles franchisés du pays. Le partenariat établi...
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Bilingual Auto Claims, Customer Care Associate
3 months ago
Montréal, Canada Definity Financial Corporation Full timeJob ID : 6790 Category : Claims Brand : Definity Regular/Temporary : Regular Fulltime/Parttime : Full Time Location : Montreal, Canada Definity includes some of Canada’s most long-standing and innovative insurance brands, including Economical Insurance, Sonnet Insurance, Family Insurance Solutions, and Petline Insurance. With strong roots that date back...
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Training and Development Coordinator
3 months ago
Montréal, Canada Manulife Full timeWe are a leading financial services provider committed to making decisions easier and lives better for our customers and colleagues around the world. From our environmental initiatives to our community investments, we lead with values throughout our business. To help us stand out, we help you step up, because when colleagues are healthy, respected and...
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Claims Analyst
4 months ago
Montréal, Canada Intertape Polymer Group (IPG) Full time**Aperçu de l'entreprise** Intertape Polymer Group (IPG) est une société multinationale dynamique qui se distingue par sa culture d'entreprise, à savoir une atmosphère familiale qui répond à un rendement d'entreprise de haut niveau. Nous offrons des salaires et des avantages sociaux concurrentiels et nous sommes reconnus pour l'importance que nous...
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Bilingual Customer Service Representative
1 month ago
montréal, Canada Express Scripts Inc. Full timeThe Provider Call Centre is the main venue for communication between providers and Express Script Canada regarding day-to-day claims adjudication queries. The Customer Service Representatives reflect Express Script Canada’s commitment to accessibility and responsiveness to providers. This position i
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Représentant(E) Du Service à La Clièntele
4 weeks ago
Montréal, QC, Canada The Cigna Group Full timeLe personnel du Centre d’appels à l’intention des fournisseurs agit à titre d’intermédiaire entre les fournisseurs et Express Scripts Canada en ce qui concerne les demandes quotidiennes relatives au traitement des demandes de règlement. Le représentant du Centre d’appels doit refléter l’engagement d’Express Scripts Canada en matière...
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Client Benefits Analyst
3 months ago
Montréal, Canada The Cigna Group Full timeThe primary function of the Client Benefit Technical Analyst is to act as a key point of contact for all Health Benefit inquiries and issues for our customers - insurance companies and third party administrators (TPAs). The Client Benefit Technical Analyst will ensure that relationships with our customers are effectively maintained. The Customer Services...
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Digital Mail Services Administrator
2 weeks ago
Montréal, QC, Canada Sun Life Full timeYou are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll...
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Analyste / Spécialiste / Spécialiste en Chef
3 months ago
Montréal, Canada Royal Bank of Canada Full time**Come Work with Us!** At RBC, our culture is deeply supportive and rich in opportunity and reward. You will help our clients thrive and our communities prosper, empowered by a spirit of shared purpose. Whether you’re helping clients find new opportunities, developing new technology, or providing expert advice to internal partners, you will be doing work...
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Provider Relations Representative
3 months ago
Montréal, Canada The Cigna Group Full timeThe role of Provider Relations is to accurately register healthcare providers and maintain a current database in order to support providers by delivering effective and timely communications to ensure seamless claims adjudication and claims payment. The successful incumbent will review network agreements from pharmacy, medical supplies & equipment, mental...
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Bilingual Customer Service Representative
4 days ago
montréal, Canada Express Scripts Inc. Full timeThe Provider Call Centre is the main venue for communication between providers and Express Script Canada regarding day-to-day claims adjudication queries. The Customer Service Representatives reflect Express Script Canada’s commitment to accessibility and responsiveness to providers. This position is instrumental in meeting contractual objectives and...
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Bilingual Customer Service Representative
4 days ago
montréal, Canada Express Scripts Inc. Full timeThe Provider Call Centre is the main venue for communication between providers and Express Script Canada regarding day-to-day claims adjudication queries. The Customer Service Representatives reflect Express Script Canada’s commitment to accessibility and responsiveness to providers. This position is instrumental in meeting contractual objectives and...
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Disability Case Manager
3 months ago
Montréal, Canada Desjardins Full timeAt Desjardins Insurance, our mission is to support our members, clients and partners in the event of a disability claim by providing the support and assistance they need to ensure a lasting return to health, while managing the cost of claims. To achieve this mission, we want to simplify and optimize the way we do business in order to modernize and ensure...