Bilingual Claims Adjudicator

3 weeks ago


Canada, CA Compunnel Inc. Full time

We are hiring a Claims Adjudicator for our client in the insurance industry.


Job Requirements:

• Post-secondary education or equivalent experience

• Strong customer service focus and the ability to take the initiative

• 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

• Detail oriented with quick assessment skills

• Excellent interpersonal skills and the ability to interact and work with others at all levels to achieve customer resolution

• Superior 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


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)


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