Bilingual Claims Examiner

3 weeks ago

Burlington, Ontario, Canada Co-operators Full time

About CUMIS

CUMIS is a leading Canadian financial services co-operative dedicated to building a sustainable and resilient society. We prioritize our people, fostering a strong culture and development opportunities that empower our team to thrive and live our purpose.

The Opportunity:

Our national Creditor team strives to develop and deliver market-leading products and solutions that exceed client expectations. We operate with integrity, driven by a commitment to doing the right thing for our clients and their members.

Your Role:

As a Bilingual Claims Examiner II, you will adjudicate and independently manage a caseload of disability claims for straightforward creditor products. This includes Single Premium (SP), Monthly Premium (MP) under $50,000, and Credit Card. Your responsibilities encompass:

  • Assessing eligibility for disability benefits
  • Developing case management plans
  • Initiating and implementing interventions to minimize claim durations
  • Calculating, authorizing, and issuing disability benefits

Your Impact:

You will:

  • Request additional information, including medical records, independent assessments, or other professional consultations.
  • Interview claimants, employers, and loan officers by telephone prior to making claim decisions.
  • Determine if a claim is payable based on the information received, gathered resources, and policy provisions.
  • Accurately calculate the benefit amount.
  • Ensure timely and appropriate decisions regarding continued eligibility are made for your assigned caseload of open claims.
  • Develop and execute proactive case management plans for each claim, aiming to minimize the disability period.
  • Communicate clearly and comprehensively with claimants, employers, loan officers, physicians, treatment providers, and internal staff such as client service representatives, filed staff, and other parties.
  • Actively and accurately present and discuss claim decisions and management plans with senior claims examiners, team leads, managers, or other internal resources through the claim referral process.

Your Success:

You will thrive in this role if you:

  • Adapt to change and are committed to continuous improvement, exceeding client expectations.
  • Possess strong communication skills, enabling you to convey messages clearly.
  • Are an effective team player who shares knowledge to support your peers.

Qualifications:

To be successful in this role, you will need:

  • Relevant experience in claims handling within the financial services industry.
  • Strong analytical and problem-solving skills.
  • Excellent communication and interpersonal skills.
  • Proficiency in both English and French.

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