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Health Claims Specialist

3 months ago

Toronto, Ontario, Canada iA Financial Group Full time

Position Overview

Department: Claims - Health & Dental Insurance Work Environment: Remote with occasional office presence for essential meetings Employment Type: Permanent, Full-Time

Are you a meticulous individual seeking a career within the Insurance sector?

Primary Responsibilities:

  • Assess and manage health and dental claims, ensuring precision and compliance with contractual obligations.
  • Authenticate and confirm submitted documentation, verifying provider qualifications and enforcing necessary protocols.
  • Exhibit proficiency in independently handling various claim categories while maintaining high productivity and quality benchmarks.
  • Liaise with members and providers to gather missing information, adhering to established turnaround times.
  • Recognize opportunities for process enhancements and actively contribute to their implementation.
  • Gather essential information required for claim processing, evaluate reasonable costs, and make determinations to approve or deny claims based on contractual terms.
  • Validate received documents, ensure provider acceptance, and enforce appropriate controls (R&C, maximums, etc.) according to your level of authority.

Qualifications and Skills:

  • College diploma (DCS) or equivalent experience
  • 2-3 years of relevant industry experience
  • Strong analytical abilities and sound judgment in decision-making processes.
  • Ability to work autonomously and demonstrate availability
  • Commitment to maintaining confidentiality regarding sensitive information

Preferred Qualifications:

  • Two years of experience in processing health and dental claims
  • Bilingual proficiency in French (both verbal and written communication)

Benefits Offered by iA Financial Group:

  • Competitive compensation package, including an annual bonus for all permanent staff
  • Emphasis on work-life balance, with additional Personal Leave Days beyond vacation
  • Comprehensive Wellness program supporting physical activity and wellness expenses
  • Medical and dental coverage for employees and their dependents, along with a Health Spending Account for uncovered expenses
  • Defined Benefit Pension plan to secure your retirement
  • Home office equipment program to optimize your work environment
  • Participation in our Share Purchase Plan with matching contributions from iA
  • Commitment to your professional development through our Education Assistance Program, ensuring you have the resources to advance your career at iA.