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Claims Analyst
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Cambridge, Canada Cowan Insurance Group Full time**What you will do**: - Assess and process claims in accordance with company’s service standards, procedures,and insurance policy guidelines - Obtain additional information needed to assess a claim - either through the provider or the subscriber; - Assist in identification and actualization of cost containment opportunities - Handle claim enquiries...
Claims Analyst, Case Management
2 weeks ago
**What’s the ask?**
Reporting to the Manager, TPA Claims, the Claims Analyst provides support to the department with respect to claims adjudication specifically focusing on case management. The claims Analyst is responsible for the timely and accurate review of claims information which includes reviewing complicated claims, maintaining records, conducting follow-ups and approving claims and estimates. The Claims Analyst must have excellent attention to detail and familiarity and comfort managing and overseeing the processing of medical claims efficiently, accurately, and in a manner that protects the interests of our clients while also providing satisfactory customer service. The Claims Analyst is also responsible for general technical assistance, project support and performing related tasks to assist with other initiatives supporting the strategic direction of the department.
More specifically, the Claims Analyst will:
- Assess complex claims to determine eligibility criteria, requirements, and maximums
- Analyze estimates for approval
- Review claim files
- Obtain additional information needed to assess a claim - either through a provider or a subscriber;
- Assist in identification and actualization of cost containment opportunities
- Ensure regular open lines of communication and conduct regular follow-ups with treatment providers, members, and internal and external stakeholder
- Work closely with our Medical Consultant for review and approval of claims
- Review and analyze data for completeness and accuracy
- Prepare correspondence and confidential documents
- Effectively manage a client case load
- Ensure the clients needs are met efficiently and accurately
- Interact with a variety of stakeholders, providers and other team members
- Participate in various special projects including continuous improvement initiatives
- Support other business initiatives/projects as assigned
**What does it take?**
- Post-secondary diploma in a related field or equivalent training acquired from a combination of relevant work experience and education
- 1-2 years of experience in claims management or equivalent training
- Medical knowledge and experience
- Strong attention to detail, organizational, time management and prioritization skills
- Demonstrate good judgement, reliability, and professionalism in fast paced environment
- Strong initiative, planning, and problem-solving skills, including an ability to focus on both details and results
- Ability to work under pressure
- Comfortable working independently with mínimal supervision
- Sound judgement and critical thinking skills
- Analytical, judgement and comprehension skills
- Excellent written and verbal communication skills
- Ability to work in a team as well as independently
- Excellent customer service skills and professionalism
- Bilingual, written and oral (English and French), is considered an asset
**Who we are**
Canadian-owned and operated, Cowan Insurance Group is a leading independent insurance brokerage and consulting operation, providing real value to our clients. With close to 500 employees operating out of 9 locations across Canada, we’re proud to have been named one of Canada’s Best Managed Companies since 2012.
We partner with leading national and international insurance companies to:
- deliver insurance and risk management solutions to businesses, organizations and individuals
- advise on and create retirement, group benefits, disability management and international benefits programs for employee groups.
We also offer wealth and asset management as well as financial and succession planning services to individuals, and specialize in property, casualty and credit insurance.
**What sets us apart?**
**Be in good company**
Integrity matters. It drives our award-winning workplace culture and fuels our collective desire to help our clients, employees, and communities thrive.
**Challenge your thinking**
You're valued for your passion, drive and creativity. The pace is fast, but the work is meaningful, interesting, and complex, just the way you like it.
**Grow together**
We believe in your potential. If you’re looking to develop your expertise with learning opportunities and mentoring, we’ll make that happen.
**Benefits and perks**
- Competitive salary
- Participate in our comprehensive benefits plan on day one — no waiting period
- Company-matched Retirement Savings Plan
- Company-paid training and development courses
- Community involvement
**Are you interested?**
Send in your cover letter and resume and share your unique story with us.
While we appreciate the interest of all applicants, we will contact only those selected for interviews. If you are an applicant with disabilities and require accommodations, please let us know at the time of our contact so that we may arrange for their provision.
