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Health Claims Specialist
2 weeks ago
**Health Claims Specialist**:
**Location: Hybrid
- Ontario**
Empire life is looking to hire a Health Claims Specialist to join our group solutions team
**Why pursue this opportunity**Our mission -** make insurance, investments and benefits simple, fast and easy for our customers.-
**Join a transforming business - **we are a medium-sized Canadian company in a stable industry which is rapidly transforming.-
**The environment** - we understand the importance of work-life balance and strive to provide a supportive work environment that allows our employees to achieve both personal and professional goals.-
**Play an integral role**:
- this is an opportunity that allows for you to grow your skills, while directly contributing to the business unit you are a part of.**What you’ll be working on**- Effectively manages team workflow, productivity, resource constraints/opportunities to meet service delivery objectives-
- Provide prompt and accurate response to enquiries within established service standards; acts as 2nd level escalation/review for health and dental claim appeals; identify and action trends-
- Acts as a primary point of contact for Health Claims, Customer Service Team, or other teams as required, by responding to escalated enquiries; maintains ownership of each inquiry from start to resolution; escalate issues for resolution, identifies and actions process improvements as a resultManages quality program, recommends and implements changes to procedures and training as a result, involve Manager where appropriate-
- Delivers business specific training (initial and ongoing) to employees-
- Develop & maintain content management, training and operational materials-
- Work with Group operations leaders to understand any operational changes and provide recommendations on process improvement-
- Manage various account reconciliations and accounting functions, collaborating with Group Finance leaders where necessary-
- Provide product and process knowledge and technical advice-
- Provide assistance and expertise for business requirements and test scenarios for projects, product launches, and system maintenance releases; validate changes-
- Adhere to complaint handling and privacy procedures**What we’re looking for you to have**:
- 5+ years demonstrated experience in insurance industry-
- Strong technical knowledge of medical and dental terminology-
- Pharmaceutical knowledge-
- Knowledge of word processing, spreadsheet, and database computer software-
- In-depth knowledge of Empire Life systems is an asset-
- In-depth knowledge of the financial service products, policy provisions, and administrative procedures-
- In-depth knowledge of distribution channels-
- Bilingualism (English/French) is an asset-
- Completion of a university degree or college program with successful attainment of a medical professional designation-
- GBA designation or working towards-
- Excellent organizational skills and the ability to prioritize and balance multiple tasks-
- Strong writing, listening and verbal communication skills-
- Attention to detail/accuracy in a high transactional environment-
- Well-developed analytical and problem resolution skills- **Beyond the salary**:
- For regular full-time positions, Empire Life offers a comprehensive total rewards package that includes:
- Competitive salaries with annual pay increases-
- Annual bonus program, which recognizes both strong company performance and individual contributions, for non sales positions-
- Competitive uncapped commission, for sales positions-
- A comprehensive employer-funded benefits package that includes life insurance, disability, health and dental and a generous health account-
- Flexible work arrangements and an annual allotment of personal health days.-
- Four weeks annual vacation from hire date-
- A defined contribution pension plan with generous employer matching-
- Top up programs for parental leave and compassionate leave-
- Employer-sponsored wellness and recognition programs- A cash employee referral program
**Get to know us**:
