Case Manager

Processing Letters of Guarantee, preapproval requests for all portfolios and ensuring that all cases are managed according to the processes and guidelines in place. To follow the case management process for risk carriers, maternity, emergency, third party claims, checkups, and hospitalization when applicable.

**Responsibilities**
- Reviews and processes pending letter of guarantee requests and preapprovals received based on processes/guidelines in place
- Prioritizes and processes all requests for the North/South American zone and emergency requests for other zones.
- Liaises with the different departments and contact persons as required for management of requests.
- Identifies and opens cases on the dedicated Case Management tool as per the guidelines provided (i.e.: exceeding or potentially exceeding claims authority as per carrier requirements; hospitalization/emergency for High Dollar Cases, maternity, motor vehicle accidents etc.)
- Presents the completed case file to the carrier for approval (when applicable) and performs the necessary follow up depending on the urgency of the case; ensures that all processes are followed;
- Follow ups on a regular basis on all opened cases until completion;
- Updates (when applicable) all major cases as needed and as per the process in place;
- Answers a multi-lined phone system and responds accurately to inquiries from insured members and providers accordingly (as a back up to the Case Coordinators and when needed);
- Conducts outbound calls to insured members/providers for processed claims (as a back up to the Case Coordinators);
- Addresses, and resolves sensitive situations efficiently and effectively by working closely with the Senior Case Managers and the Case Management Supervisors as required;
- Attends training sessions on an on-going basis to maintain accuracy of responses to insured members and to keep up to date on changes within the team and the company;
- Uses the following tools as needed: Medical Tool; Case Management Tool, MSH COMMUNITY etc.
- May assist with projects when needed

**Qualifications and Education Requirements**
- Post secondary education in a business administration, medical terminology, or insurance related field, or equivalent work experience
- Ability to communicate (oral and written) in English
- 1-3 years relevant business experience;
- Previous experience in the insurance and/or medical field;
- Intermediate computer skills are required.
- Attention to detail;
- Ability to multi-task and adapt to various situations;
- Strong organizational skills with strengths in prioritization and efficiencies;
- Strong customer service skills;
- Ability to work within a team environment;
- Knowledge of how to locate and interpret various company health insurance policies;
- Analytical;
- Good listening skills;
- Proactive attitude;
- Ability to sympathize and reassure clients;
- Diplomatic.

**Preferred Skills**
- Knowledge of medical or dental terminology is an asset.
- Fluency in either French or Spanish is preferred.

Additional pay:

- Overtime pay

**Benefits**:

- Company pension
- Dental care
- Disability insurance
- Employee assistance program
- Extended health care
- Life insurance
- Paid time off
- RRSP match
- Tuition reimbursement
- Vision care
- Wellness program

Schedule:

- 8 hour shift
- Day shift
- Holidays
- Monday to Friday
- Overtime
- Weekend availability

Ability to commute/relocate:

- Toronto, ON: reliably commute or plan to relocate before starting work (preferred)

**Education**:

- Bachelor's Degree (preferred)

**Language**:

- Spanish (preferred)
- French (preferred)