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Claims Adjuster

2 months ago

Canada, CA Robertson & Company Ltd. Full time

Position: Claims Adjudicator I

Contract Period: 6 months

Location: Remote (Anywhere in Canada)

Hours: Should work EST hours between 9 AM and 5 PM

Pay rate: $19/hr $20.63/hr



Job Summary:


The Claims Adjudicator is accountable for handling claims in accordance with high service standards to 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.


Key Accountabilities:


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 required

• Commitment to improving NPS (customer) scores based on overall CX goals

• Commitment to the achievement of the divisional and organizational “Must Win Battles


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


NICE TO HAVE SKILLS


  • Bilingual (English and French)
  • Previous claims experience is an asset.
  • Previous call centre experience is an asset.



We thank you for your interest in the position, however, only those who are qualified will be contacted


Inclusion and Equal Opportunity Employment

Our client is an equal opportunity employer committed to diversity and inclusion; creating an inclusive environment where all team members and clients feel like they belong. 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. We seek applicants with a wide range of abilities, and we provide an accessible candidate experience; accommodations during the application process are available upon request.