Medical Claims Specialist

3 weeks ago

Oakville, Ontario, Canada Travelers Full time
Join Our Team as a Medical Claims Specialist

We are seeking a highly skilled Medical Claims Specialist to join our team at Travelers. As a Medical Claims Specialist, you will play a critical role in supporting our claim professionals by providing medical expertise and serving as a technical resource.

Key Responsibilities:
  • Interpret routine, complex, or unique medical information and evaluate medical treatment to provide medical judgment in alignment with company policies and service values.
  • Discuss medical information with claim handlers to assist in developing a claim medical resolution strategy and assist claim handlers in projecting medical costs of claims.
  • Provide objective, concise documentation of medical reviews in approved report formats or in claim notes and maintain accurate productivity records.
  • Research medical information to support the claim review process and identify medical trends for use in developing and recommending training programs.
  • Respond to claim requests for training as needed.
Requirements:
  • Chiropractor or licensed medical professional.
  • Strong knowledge of medical causation and relatedness.
  • Knowledge of jurisdiction-specific medical guidelines.
  • Computer skills to include Microsoft Word, Excel, and Outlook.
  • Strong relationship-building skills with the ability to work both independently and collaboratively with internal and external partners.
What We Offer:
  • Employees and their eligible family members – including spouses, partners, and children – are eligible for coverage from the first day of employment.
  • Twelve paid company holidays.
  • A mental health program providing access to free professional counseling services, health coaching, and other resources to support daily life needs.
  • A volunteer encouragement program that supports our commitment to the communities we serve.

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