Claims Examiner

4 days ago


Windsor, Ontario, Canada Global Excel Management Inc Full time
About the Role

As a Claims Examiner at Global Excel Management Inc, you will play a crucial role in evaluating and processing claims related to non-medical benefits. Your primary responsibility will be to assess and apply the relevant benefits and limitations based on a comprehensive understanding of the applicable policy wording.

Key Responsibilities
  • Review policy wording to validate coverage;
  • Examine claims with precision to ensure compliance with client directives, when applicable;
  • Determine the presence of claim requirements according to policy wording (i.e., proof of payment and authenticity of claims/invoices);
  • Conduct research and confirm global influences on claims (i.e., travel advisories);
  • Communicate with clients to request missing claim components, as needed, for decision-making purposes;
  • Clarify and explain denials, as needed;
  • Notify clients of claim decisions via email, phone, or official letter;
  • Maintain appropriate workflow tracking processes;
  • Confirm and modify (as needed) claim wording.
Requirements
  • Diploma in a related field or equivalent;
  • Knowledge of insurance benefits and limitations;
  • One to two years of customer service experience;
  • Strong decision-making and attention-to-detail skills;
  • Excellent communication (both written and verbal) skills;
  • Good organizational skills and ability to prioritize tasks;
  • Proficiency in Microsoft Office products;
  • Ability to communicate clearly and effectively in English or French, both written and verbally. Knowledge of another language, such as Spanish, is an asset.
  • English will be used to work closely with our Windsor, Ontario office team and conduct daily follow-ups with other departments across our various offices in Ontario, Miami, Mexico, and other locations.
  • Available to work daytime hours; May be required to work evenings and weekends with advance notice.
What We Offer
  • Competitive salary;
  • Bilingualism premium, if applicable;
  • Group insurance plan including health and dental coverage, with employer-matched RRSP contributions;
  • Reimbursed training and opportunities for professional development;
  • Possibility of career advancement and professional growth;
  • Work-life balance support;
  • Employee wellness program, including an excellent employee assistance program;
  • Employee engagement program focused on health, nutrition, and fun.

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