Medical Claims Reviewer

2 weeks ago

Toronto, Canada Zurich Insurance Full time

Job SummaryZurich Insurance is a global insurance company with a specialty in life insurance, general insurance and travel insurance. This role will sit in one of Zurich’s subsidiary companies, World Travel Protection, which focuses on providing travel risk management and emergency assistance support.

World Travel Protection (WTP) is a leading travel assistance and Travel Risk Management (TRM), company. WTP provides robust response solutions to logístical, security and medical emergencies for travellers based on its global reach and through its worldwide provider network. Through this network, WTP is able to effectively resolve incidents inherent to international traveling. Prevention is also at the forefront of WTP through a wide range of risks mitigation and security assistance solutions available to its clients to ensure that their resources are best utilised to anticipate crisis from occurring.
- **Grow your Medical Claims career**:

- **Join a team that really cares about our customers**:

- **Enjoy a culture focused on results, allowing flexibility on when and where you work**

World Travel Protection provides global travellers with specialist emergency assistance services when something goes wrong in their travels. We operate 24 hours a day, seven days a week from our operation centres in Australia, Canada, the United Kingdom, and Malaysia, responding to the cries for help we receive from travellers across the globe.

Owned by Zurich, but with separately managed business entities, we can truly offer you a world of possibilities within assistance and insurance. Get ready to do your best work and then some.

The World Travel Protection Medical Claims Reviewer facilitates the policyholder injured employees’ medical treatment to ensure quality, effective and cost-efficient care. Coordinates with vendors of rehabilitative services to confirm that services are consistent with the injury and the goal of returning the injured person to employability and normal activities or maximum medical improvement.
- A bit about the job:
- Ensure customer satisfaction by making contact with the client, medical provider and claim professional in a timely manner and according to Best Practices.
- Ensure customer service by proactively communicating information; responding to inquiries; and following customer specific protocols.
- Establish a case management plan by completing evaluation and recommend plan of action.
- Coordinate and communicate activities of the case management plan by maintaining ongoing communication with client, provider(s), and claim professional as appropriate and according to Best Practices.
- Manage activities associated with case by completing assignments from claims staff, utilizing Managed Care tools (Preferred Provider Organizations, preferred vendors), addressing issues and escalating as appropriate.
- Document information according to Best Practices (including case assessment, case management plan, follow-up communication, closure, billing, cost containment and return to work data).
- Meet quality standards by following best practices.
- Manage appropriate case load according to policy and ensure accurate billing of all case management activity.
- Ensure legal compliance by following state and federal laws and regulations and internal control requirements.
- Acts as a technical resources by participating in presentations and provide education/ training sessions as needed, and/ or as requested by Manager.
- Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks, and participating in professional societies.
- Contribute to the team effort by accomplishing related results and participating on projects as needed.
- Protect Zurich’s reputation by keeping claims information confidential.
- Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks, and participating in professional societies.
- Contribute to the team effort by accomplishing related results and participating on projects as needed.

A bit about you:
- Required:

- Bachelors Degree and 2 or more years of experience in the Clinical In Medical, Surgical, Orthopedic, Neuro-Surgery area
- AND- Case Management
- CRRN
- CDMS
- CCM
- CRC

**Preferred**:

- Experience in insurance industry, workers compensation, and/or managed care
- Bilingual skills in either French or Spanish
- Strong verbal and written communication skills
- Experience working in a team-based environment coordinating client care
- Microsoft Office skills- Why pick us:
- There’s no one size fits all option when it comes to flexibility. It looks to us the same as it does to you so let us know how we can accommodate you.
- You’ll be part of a global team of trainers with the capacity to contribute to ongoing growth and development of the business.
- We’ll h

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