Claims Assessment Specialist
4 weeks ago
JOB DESCRIPTION:
As a Non-Medical Claims Analyst, your primary responsibility will be to evaluate and apply benefits and restrictions associated with claim submissions, grounded in a thorough understanding of the relevant policy language. This position entails determining the eligibility of claims or invoices for payment and conducting service reviews, which may involve direct interaction with clients.
What does a typical day look like?
- Analyzing the relevant policy language to confirm coverage;
- Precisely evaluating claims to ensure adherence to client standards;
- Verifying claim prerequisites in accordance with policy language (e.g., proof of payment and authenticity of invoices/claims);
- Investigating and validating the overall implications of claims (e.g., travel advisories);
- Engaging with clients to request any missing components necessary for decision-making;
- Clarifying and elucidating denials when required;
- Communicating claim decisions through email, phone, or formal letters;
- Establishing appropriate follow-up workflows;
- Confirming and modifying claim language as necessary.
What skills and qualifications are we looking for?
- College diploma or equivalent;
- Understanding of insurance product benefits and limitations;
- One to two years of experience in customer service;
- Strong analytical skills and meticulous attention to detail;
- Exceptional communication skills (both verbal and written);
- Good organizational abilities and capacity to prioritize tasks;
- Proficiency in Microsoft Office applications;
- Effective communication in English or French, with knowledge of an additional language such as Spanish being advantageous;
- Willingness to work during the day, with potential evening and weekend shifts with prior notice.
WHAT WE OFFER:
- Competitive salary;
- Bilingualism bonus, if applicable;
- Comprehensive group insurance plan including healthcare and dental benefits, along with equal RRSP contributions;
- Paid training and opportunities for professional development;
- Opportunities for career advancement and growth;
- Work-life balance;
- Employee health and wellness programs, including an excellent employee assistance program;
- Employee engagement initiatives focusing on health, nutrition, and enjoyable activities.
About Our Company:
Global Excel is a premier provider of global healthcare risk management solutions. For more information about our company culture and values, please visit our website.
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