Claims Examiner
6 months ago
_**It's fun to work in a company where passion meets profession, and every team member is not just an employee but a dedicated enthusiast, making the work journey truly enjoyable and fulfilling**_
**About Us**:
We are seeking ambitious individuals who share our values and our passion for making a positive impact on people's lives around the world. If you are looking for a career that challenges and inspires you, you've come to the right place.
**About You**
The Claims Examiner will be responsible for processing a variety of different claims and communicating
these decisions to providers and clients. This role requires strong time management skills,
claims experience, and strong Excel skills.
**In this role, you’ll get to experience**:
- Process EU and UK health, dental, and pharmacy claims
- Adjudicate claims based on approved Letter of Guarantee periods for the client
- Provide excellent customer service for claims matters both verbal and written
correspondence
- Handle both inbound and outbound calls to EU/UK health providers as required
- Ensure all work complies with the PIPEDA and GDPR
- Reconciliation of claims with Healthcare providers
- Data Entry is required to key in scanned claims/invoices into the V9 system
- Maintain concise file documentation consistent with corporate policies
- Provide overall portfolio management of assigned claims files
- Provide guidance and mentorship to peers
- courier/mail management
- Other related duties as assigned
**What you bring**:
- High school diploma or equivalent
**Required Skills**:
- Experience in the EU/UK health insurance industry is required
- Minimum 2-3 years of claims processing experience
- Experience in processing health, dental, and pharmacy claims
- High level of proficiency in Microsoft Office suites, specifically Excel
- Superior verbal and written communication skills
- Strong time management and organizational skills
- Strong analytical and problem-solving skills
**What do you need to succeed?**
- 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**
- The hours for this position are 9 am-5pm EST from Monday through Friday. Occasional overtime on evenings and weekends is required.
**What’s in it for you**:
- Hybrid work environment
- Excellent health benefits
- Employee assistance program
- Wellness account
- RRSP matching
- Minimum 3 weeks’ vacation
- Generous amount of sick and flex days
- Tuition reimbursement program
- Opportunities to learn new skills, grow, and move into different roles
- A work environment that embraces diversity and promotes inclusivity.
- Supportive leadership prioritizes your success and cares about your well-being.
- A growth trajectory designed to expand vertically and horizontally, providing opportunities to pursue your passions and acquire new skills.
**Benefits**:
- Company events
- Dental care
- Disability insurance
- Employee assistance program
- Extended health care
- Flexible schedule
- On-site parking
- Paid time off
- RRSP match
- Tuition reimbursement
- Vision care
- Wellness program
Schedule:
- Monday to Friday
- On call
Supplemental pay types:
- Bonus pay
- Overtime pay
Work Location: Hybrid remote in Toronto, ON M5H 1J9
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