Bilingual Claims Adjudicator

2 weeks ago

Toronto, Canada Canada Protection Plan Full time

Are you looking to be part of a continually growing and dynamic company that is a leader in the life insurance industry? Canada Protection Plan, a Foresters Financial company operating in the Canadian marketplace, markets and sells life insurance and related products, many with simplified underwriting processes requiring no medical exams.

Would you like to make a difference with the customers we serve? A career at Canada Protection Plan, the Canada Division of Foresters Financial, is full of potential. We are driven to excel, and our employees reflect this passion. Our company values include shared collaboration, career development and a friendly and open work environment.

Our strength is a culture characterized by doing work that makes a positive impact in the communities where we live. We connect with our employees in significant and meaningful ways for work that matters.

As a Member of the Claims team the incumbent will be accountable for ensuring that all claims are adjudicated and administered according to state and provincial law and regulations and in a fair, ethical and efficient manner.

**Duties will include**:

- Adjudicate various types of complex claims, including Life, Critical Illness and Accelerated Death Benefit claims. This includes identifying, collecting and reviewing all relevant information needed to determine the claim legitimacy and eligibility as well as the benefit amount payable.
- Familiarization with the requirements of the appropriate provincial/state legislation and/or regulations related to the type of claim being reviewed.
- Perform all necessary benefit calculations and ensure all related activities are in compliance with provincial/state statutory and internal standards.
- Communicate effectively with outside resources such as medical consultants, legal consultants, independent physicians, coroners, police or investigative services.
- Determine which claims need to be referred for evaluation and decision, based on authority limits, business case issues or referral to legal counsel.
- Maintain and update system records as necessary.

**Knowledge/Experience/Skills**:

- 3-4 years experience adjudicating life insurance and living benefit claims;
- College Diploma or University Degree an asset
- Knowledge of claims adjudication theory, principles, methods, systems, processes and standards including an understanding of insurance medicine and actuarial principles/methods as they relate to the claims function.
- Self starter with demonstrated ability to prioritize case load and ability to research/problem solve and make decisions both independently and collaboratively within a fast paced team environment
- Advanced verbal and written communication skills to effectively communicate with internal and external customers/partners and vendors.
- Strong reasoning and judgment to balance commitments, financial soundness and quality customer focus
- Strong analytical skills for research, review and assessment of claims.
- LOMA/ALHC designation an asset.
- Bilingual (French) written and oral communication required.

At Canada Protection Plan and Foresters Financial, we are committed to fostering an inclusive, accessible environment, where all employees and customers feel valued, respected, and supported. We are dedicated to building a diverse workforce and we are an equal opportunity employer.

We thank all applicants for their interest, however, only those considered for an interview will be contacted.

INDCPP

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