Claims Examiner

1 week ago


toronto, Canada AppleOne Employment Services Full time

Claims ExaminerToronto (Remote)$25-27ph 6 month temp with potential to go permanentOur client is seeking an experienced Claims Examiner to join their growing team.If you have hands-on experience in claims adjudication, especially within travel or medical insurance, and you’re passionate about delivering exceptional customer service, we’d love to hear from you.About the RoleAs a Claims Examiner, you will be responsible for reviewing, assessing, and adjudicating a variety of travel insurance claims. You will work closely with claimants, providers, industry partners, and internal teams to ensure timely, accurate, and fair claim resolutions all while maintaining compliance with regulatory standards and upholding high service expectations.Key ResponsibilitiesProcess travel insurance claims (medical, trip cancellation/interruption, baggage, dental, vision) within designated approval limitsAdjudicate claims in alignment with applicable benefit policies and coverage guidelinesHandle inbound/outbound calls and written correspondence, delivering exceptional customer serviceCollaborate with claimants, providers, agents/brokers, and other insurance carriersWork cross-functionally with internal departments to support daily operationsMaintain thorough claim file documentation and adjust reserves in accordance with insurer standardsParticipate in file reviews, appeal discussions, and case presentationsEnsure compliance with privacy regulations including PIPEDA and HIPAAMentor team members and support departmental projects and initiativesRequired QualificationsHigh school diploma or post-secondary education2–3 years of experience in travel or medical insurance claims processing preferredBilingual in English/French AssetStrong analytical and problem-solving skillsProficiency in Microsoft Office SuiteExcellent verbal and written communication abilitiesEffective time management and strong organizational skillsPreferred ExperienceBackground in snowbird, expatriate insurance, or third-party administration (TPA)Experience handling Canadian and U.S. medical invoices/claimsKnowledge of dispute resolution processesFamiliarity with GHIP recovery, coordination of benefits, or subrogationDisclaimer: This is currently for an active job opportunity.By applying, you will be part of our trusted network, ensuring our recruiters match you with suitable roles. Let us help you take the next step in your career journey



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