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Claims Resolution Specialist

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Toronto, Ontario, Canada MSH Americas - Diot-Siaci Group Full time

About the Role:

We are seeking a highly skilled Dispute Resolution Specialist to join our team at MSH Americas - Diot-Siaci Group. As a key member of our claims resolution team, you will be responsible for investigating and resolving claims issues, complaints, disputes, and queries in a timely and professional manner.

Key Responsibilities:

  • Investigate and research escalated complaints, issues, and queries from various sources, including insureds, human resource administrators, clients, call centers, adjudicators, and account management.
  • Document all disputes meticulously, following the established dispute resolution process, and maintain and update the complaint (reclamation) workflow.
  • Conduct a comprehensive initial investigation for each dispute to determine their validity and root causes.
  • Review corrective measures with the VP of Claims before implementation.
  • Collaborate with internal teams (adjudicators, call center, QA, training, supervisors, account management, accounting) to propose recommended resolutions for each dispute, ensuring alignment with service level targets.
  • Ensure timely communication by providing updates to both internal and external stakeholders throughout the dispute resolution process.
  • Take charge of handling escalations from start to finish.
  • Closing the loop with the member, ensuring not only resolution but also maintaining effective communication channels throughout the process.

Requirements:

  • Completion of Post-Secondary education in Business, Insurance, Legal Studies, or equivalent work experience.
  • 1-3 years of proven experience in claims processing or dispute resolution within the insurance industry.
  • Proficient in utilizing internet and email platforms and intermediate proficiency in Microsoft Office applications.
  • Familiarity with insurance policies, regulations, and industry standards.
  • Must be fluent in English and French.

What We Offer:

  • 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.