Office Adjuster
3 weeks ago
Position: Claims Adjudicator I Contract Period: 6 months
Location: Remote (Anywhere in Canada)
The Claims Adjudicator is accountable for handling claims in accordance with high service standards to meet or surpass client expectations. 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.
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..
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)
Previous claims adjudication and/or relevant insurance or health care industry experience a definite asset
• Strong working knowledge of Microsoft Office 365 suite of programs
• Bilingual (English and French)
Previous claims experience is an asset.
Previous call centre experience is an asset.
Inclusion and Equal Opportunity Employment
Our client is an equal opportunity employer committed to diversity and inclusion; We are pleased to consider all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, Aboriginal/Native American status or any other legally-protected factors.
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