Claims Analyst
5 months ago
You have
**attention to detail **to review, examine and process claims to ensure the client’s needs are met efficiently and accurately.
You can work in a **team** to help assist with project support and performing related tasks to assist with other initiatives supporting the strategic direction of the department.
If you are nodding yes, this **Claims Analyst** role in our Third-Party Administration department at Cowan Insurance Group may be perfect for you
**What’s the ask?**
Reporting to the Manager, TPA Claims, the Claims Analyst is responsible for the adjudication of medical claims in accordance with claim processing guidelines.
**Key Responsibilities**:
- Assess and process claims in accordance with company’s service standards, procedures, and insurance policy guidelines
- Obtain additional information needed to assess a claim - either through the provider or the subscriber;
- Assist in identification and actualization of cost containment opportunities
- Handle claim enquiries ranging from basic to complex in nature
- Seek advice from designated team members on complicated cases or claims above authority limit
- Identify and investigate claims for possible abuse and fraud
- Utilizes all applicable system functions available ensuring accurate and timely claim processing service
- Escalate unresolved claims complaints and high costs claims to the supervisor for guidance
- Continually work to improve best practices procedures and standards
- Deal with confidential and sensitive medical and personal information
- Work closely with our case management team for review and approval of claims
- Review and analyze data for completeness and accuracy
- Prepare correspondence and confidential documents
- Interact with a variety of stakeholders, providers and other team members
- Participate in various special projects including continuous improvement initiatives
- Support other business initiatives/projects as assigned
**What does it take?**
- Post-secondary diploma in a related field or equivalent training acquired from a combination of relevant work experience and education
- 1-2 years of experience in claims management or equivalent training
- Medical knowledge and experience
- Strong attention to detail, organizational, time management and prioritization skills
- Demonstrate good judgement, reliability, and professionalism in fast paced environment
- Strong initiative, planning, and problem-solving skills, including an ability to focus on both details and results
- Ability to work under pressure
- Comfortable working independently with mínimal supervision
- Sound judgement and critical thinking skills
- Analytical, judgement and comprehension skills
- Excellent written and verbal communication skills
- Ability to work in a team as well as independently
- Excellent customer service skills and professionalism
- Bilingual, written and oral (English and French), is considered an asset
**Who we are**
Canadian-owned and operated, Cowan Insurance Group is a leading independent insurance brokerage and consulting operation, providing real value to our clients. With over 500 employees operating out of 8 locations across Canada, we’re proud to have been named one of Canada’s Best Managed Companies since 2012.
We partner with leading national and international insurance companies to:
- deliver insurance and risk management solutions to businesses, organizations and individuals
- advise on and create retirement, group benefits, disability management and international benefits programs for employee groups.
We also offer wealth and asset management as well as financial and succession planning services to individuals, and specialize in property, casualty and credit insurance.
**What sets us apart?**
**Be in good company**
***Integrity matters. It drives our award-winning workplace culture and fuels our collective desire to help our clients, employees, and communities thrive.
**Challenge your thinking**
***You're valued for your passion, drive and creativity. The pace is fast but the work is meaningful, interesting, and complex, just the way you like it.
**Grow together**
We believe in your potential. If you’re looking to develop your expertise with learning opportunities and mentoring, we’ll make that happen.
**Benefits and perks**
- Competitive salary
- Participate in our comprehensive benefits plan on day one — no waiting period
- Company-matched Retirement Savings Plan
- Company-paid training and development courses
- Community involvement
- Hybrid work environment
**Are you interested?**
Send your cover letter and resume and share your unique story with us.
While we appreciate the interest of all applicants, we will contact only those selected for interviews. If you are an applicant with disabilities and require accommodations, please let us know at the time of our contact so that we may arrange for their provision.
**#LI-Hybrid
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