Claims Examiner

3 weeks ago

Toronto, Canada MSH International Full time

**Job Overview**

As a Claims Examiner, your primary responsibility will involve processing a diverse range of claims while effectively communicating these decisions to both providers and clients. Your ability to effectively manage time, coupled with your extensive claims experience and advanced Excel skills, will be instrumental in achieving excellence in this role.

**Responsibilities**

**- **Process health, dental, and pharmacy claims for clients in the US, EU, and UK regions.
- Adjudicate claims based on approved Letter of Guarantee periods, ensuring compliance with client policies.
- Deliver exceptional customer service through both verbal and written correspondence, addressing inquiries and concerns related to claims.
- Handle inbound and outbound calls to healthcare providers in the US, EU, and UK as necessary.
- Uphold compliance with privacy regulations such as PIPEDA, GDPR, and HIPAA throughout all claim-related activities.
- Perform reconciliation of claims with healthcare providers, ensuring accuracy and resolving any discrepancies.
- Utilize data entry skills to accurately input scanned claims and invoices into the V9 system.
- Maintain meticulous file documentation in alignment with corporate policies, ensuring clarity and completeness.
- Manage assigned claims files, overseeing the portfolio and ensuring efficient resolution.
- Offer guidance and mentorship to peers, fostering a collaborative and supportive work environment.
- Manage courier and mail services, ensuring timely delivery and receipt of important documents.
- Undertake additional duties as assigned, contributing to the overall efficiency and success of the claims department

**Qualifications and Education Requirements**
- Possess a high school diploma or an equivalent qualification.
- Demonstrated experience in the health insurance industry within the US, EU, or UK is mandatory.
- Minimum of 2-3 years of hands-on experience in claims processing, showcasing a comprehensive understanding of the intricacies involved.
- Proficient in processing various types of claims, including health, dental, and pharmacy claims.
- Advanced proficiency in Microsoft Office suites, with a particular emphasis on Excel, enabling effective data analysis and manipulation.
- Exemplary verbal and written communication skills, enabling clear and concise interaction with clients, providers, and internal stakeholders.
- Strong time management and organizational abilities, allowing for efficient handling of multiple tasks and meeting tight deadlines.
- Exceptional analytical and problem-solving skills, enabling accurate assessment and resolution of complex claims-related issues.

**Preferred Skills**
- Cost containment/provider relations experience
- Proficiency in Arabic, German, and French language is a plus.
- Experience with medical coding standards
- Dispute resolutions experience

**Additional Notes**
- Our work week is Monday to Friday, 8 hours per day. The hours are flexible with start times between 8 am and 10 am. Occasional flexibility in hours is required to meet the needs of the business.
- A laptop will be provided

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

**Benefits**:

- Dental care
- Extended health care
- Life insurance
- Paid time off
- RRSP match
- Tuition reimbursement
- Wellness program
- Work from home

Flexible Language Requirement:

- French not required

Schedule:

- 8 hour shift
- Monday to Friday

Supplemental pay types:

- Bonus pay
- Overtime pay

Ability to commute/relocate:

- Toronto, ON M5H 1J9: reliably commute or plan to relocate before starting work (required)

Work Location: Hybrid remote in Toronto, ON M5H 1J9

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