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Claims Specialist
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Claims Adjudicator
2 months ago
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
• 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)
