Claims Examiner

1 week ago

Richmond, Canada TuGo Full time

**Claims Examiner - Case Coordinator Hybrid Role**

**What you'll do**:
You process claim files according to Company policies and procedures. This involves reviewing claims, recommending payment or denial, or requesting additional information. You process approved payments and/or denials for travellers and providers and set up payment requests from other insurers. You also are a critical part of our Medical Assistance Team by answering calls and coordinating the immediate medical needs of our travellers, with the support of Case Managers and TuGo Physicians.

Specifically you will:

- Process claims according to Company policies and procedures. This involves reviewing claims for completeness and compliance with policy coverage and recommending acceptance or denial of claim and expenses.
- If claim requires additional supporting documentation to confirm payability, request and review medical history, medical records, itemized bill, etc. following established SOPs.
- Process payments and/or denials to travellers and/or providers.
- Set up requests for payment from provincial medical plans, extended health plans and any other insurers.
- Perform duties of a Medical Assistance Case Coordinator as needed and as directed by your supervisor.
- Achieve performance targets.
- Collaborate and communicate effectively with team members and all other teams. 
- Responsively and effectively handle issues.
- Look for ways to improve customer experience.
- Promote and model TuGo culture, values, and brand promise.
- Continuously build professional and technical expertise.
- Other duties as required.

**What you'll bring**:

- Degree or Diploma in a business-related discipline
- Successful completion of Level 1 Insurance Adjuster’s Licence or Level 1 General Insurance Licence (within first year of employment)
- Level 2 Insurance Adjuster’s Licence or Level 2 General Insurance Licence is an asset
- Strong analytical, problem solving and decision-making skills, detail-oriented and well organized
- Excellent written and verbal skills
- Fluency in an additional language - preferably French, Spanish, Mandarin, or Cantonese - is an asset
- Previous experience assessing claims is an asset
- Experience in customer service is an asset
- Ability to multi-task
- Strong interpersonal, and conflict resolution skills
- Knowledge of medical terminology is an asset
- Criminal record check is a requirement of the position as required by insurance councils for licensing
- Once fully trained, work schedule will include some non-business hour shifts (weekend and evening shifts)
- Strong team player and positive contributor
- Able to consistently live our values of valued, effective and trusted
- A strong customer experience focus
- A passion for continuous learning and professional achievement

**Job Types**: Full-time, Permanent

Pay: $50,000.00-$66,000.00 per year

**Benefits**:

- Casual dress
- Company events
- Dental care
- Disability insurance
- Employee assistance program
- Extended health care
- Life insurance
- Paid time off
- RRSP match
- Vision care
- Work from home

Schedule:

- Day shift
- Evening shift
- Morning shift
- On call

Work Location: Hybrid remote in Richmond, BC V6Y 2B2

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