Medical Claim Reviewer

Job Summary- World Travel Protection Canada Inc. (WTP- a division of Zurich Canada Holdings) is a unique and specialised service provider with over 25 years of diverse industry experience including emergency medical, travel security, travel assistance services and solutions to clients all over the globe. We offer emergency assistance services 24/7/365 with highly trained personnel including medically qualified staff (doctors & nurses) and medical case management as well as logistics specialists. WTP provides full spectrum of Third Party Administration (TPA) services including claims management for the travel insurance industry. Over the years WTP has earned the reputation of a quality service provider. Thus, the name WTP has become synonymous with quality and dependability.- As a global assistance organization, we all belong to one global group with a shared goal of looking after our customers—their dreams, aspirations and the memories they are yet to make. We want to attract and retain talent that appreciates and can contribute to this aspiration. This is based on our core values of Optimism, Caring, Reliability, Determination and Togetherness. Throughout the pandemic that has impacted so many lives and industries, it has never been more clear that success through these core values is part of our DNA. If you share this type of outlook, perhaps you may find a good fit here at World Travel Protection.-
- A Claims Medical Reviewer provides clinical expertise to customers travelling around the world. They collaborate with claims examiners, claims manager, healthcare providers, underwriters and special vendors to ensure the overall review of a medical claim is in accordance with the terms & conditions of the insurance policy. A Claims Medical Reviewer provides outstanding services to our clients and customers, in alignment with company values, vision & mission, and in compliance with necessary regulatory obligations.- What you will do:
- Establish a case review plan by completing evaluation and recommend plan of action.
- Manage activities associated with case by completing assignments from claims staff, utilizing Managed Care tools (Preferred Provider Organizations, preferred vendors), addressing issues and escalating as appropriate.
- Document information according to Best Practices (including case assessment, case management plan, follow-up communication, closure, billing, cost containment and return to work data).
- Meet quality standards by following best practices.
- Manage appropriate case load according to policy and ensure accurate billing of all case management activity.
- Ensure legal compliance by following state and federal laws and regulations and internal control requirements.
- Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks, and participating in professional societies.
- Contribute to the team effort by accomplishing related results and participating on projects as needed.
- Protect WTP and Zurich’s reputation by keeping claims information confidential.
- Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks, and participating in professional societies.
- Contribute to the team effort by accomplishing related results and participating on project.
- What you bring to the table:- Display high energy, passion and a positive attitude Own the results and willingly seek and accept personal accountability Seek opportunities to continuously learn about new products, policies and client priorities and their expectations Assign a high priority to customer service excellence and understand the value of customer satisfaction in driving success be flexible and personally embrace change.**Unique Requirements**:

- Accurate data entry, review of medical records, decision making, analytical skills.**Assets**:

- Fluent in additional languages, particularly French or Spanish- Knowledge of privacy acts: PIPEDA and HIPAA Previous Case Management experience Case Management certification, CRRN, CDMS, CCM or CRC Experience in travel insurance industry and/or managed care Experience in healthcare system of the United States & Canada**What we bring to the table**:

- A comprehensive health/benefits plan with varying levels of coverage to suit your specific needs- A competitive total compensation package- A chance to work in the exciting world of insurance, with multiple career paths and the opportunity to grow - we encourage internal mobility and take pride in assisting you to reach your career goals and aspirations**We also offer you the opportunity to work with**:

- A people first organization, with a focus on diversity and inclusion - we encourage you to bring your real self to work- An organization that values your input, and strives to put our employees in a position to make an impact- A co