Claims Examiner

Reporting to the Manager, the Claims Examiner is responsible for handling, evaluating and assessing medical and dental claims for our insureds in an accurate and efficient manner. You will be expected to be an active team member by supporting work efforts, providing feedback while ensuring customer service excellence. This is a full-time, salaried role with eligibility to a robust benefit plan.

**guard.me** International Insurance recognizes people as our most valuable asset. We look for individuals who like working with and helping people and who are interested in long-term career growth within an established, successful company. The work environment is fast-paced and high-energy. You'll get a chance to communicate with others, as everyone's input is valued. The culture is truly collaborative. You'll be working with an established award-winning team with an impressive track record.

If we still have your attention, please read through the responsibilities and qualifications and if you think you’re a good fit, we’d love to review your resume

**Responsibilities**:

- Required to thoroughly review claim submission documentation and data entry
- Detailed analysis required to determine if additional information or documentation is required and delegate tasks accordingly
- Determine eligibility in an accurate and prompt manner based on policy guidelines and in line with **guard.me **authority limits
- Provide reserve recommendations and adjust reserves accordingly
- Refer cases outside of authority level, preparing referral documentation and materials as appropriate
- Communicating assessment determination to claimants, when applicable
- Utilizing critical thinking and solid judgment to solve problems, make decisions and resolve complex issues inherent in handling losses
- Present and resolve claim disputes to ensure claims were assessed fairly and in accordance with policy guidelines and ensuring high standards are always met
- Investigating potentially fraudulent claims and taking appropriate action
- Maintain proper electronic files for claims by collecting, reviewing and organizing all relevant documents and set up new claims using the company software system
- Keep up to date with insurance product knowledge as well as appraisal and investigation techniques and services
- Liaise with other departments to solve queries as necessary
- Any other duties as required to assist Claims Team in times of high claims volume and peak periods

**Education & Experience**
- Minimum of 5 years’ experience in Claims Examination, ideally medical and dental claims
- Completion of Secondary School Diploma, or equivalent combination of education and experience preferred in an Insurance, Medical or Clinical setting

**Qualifications and Skills**
- A strong attention to detail with the ability to multi-task
- Ability to maintain high-level of confidentiality of clients’ information
- Demonstrate decision making ability
- Proficiency with mathematics
- Excellent customer service attitude with an ability to demonstrate this while taking calls
- Excellent verbal & telephone skills with the ability to maintain a calm and professional demeanor
- Excellent written communication skills with the ability to compose professional correspondence in English
- Solid teaming skills to work collaboratively in a positive, energetic and outgoing manner
- Comfortable adapting to new situations with the ability to perform well, negotiate and problem solve in dynamic situations
- Experience using Microsoft Office (Word/Excel/Outlook), Adobe Reader, Internet Search Engines (Google Chrome, Mozilla, IE), Tech-savvy with the ability to learn new computer systems and work with industry related software programs
- Case Management, Medical, Nursing and/or Pharmaceutical knowledge an asset
- Ability to communicate in a second language is an asset

**How to Apply**:
Disclaimer: Please note that this document is intended to provide an overview of job accountabilities and does not necessarily list all tasks related to the job.

**About Us**

**guard.me International Insurance** is the premier provider of quality healthcare insurance to the International Education and Travel Market. We provide comprehensive health insurance products for international students who are studying in Canada and for international students who are studying outside of Canada, as well as teachers and participants in exchange, co-op and work abroad programs. Since 1994, we have continually worked to exceed the expectations of our clients by offering superior service, comprehensive policy benefits and fast efficient claims processing that continue to surpass industry standards.

**Job Types**: Full-time, Permanent

**Salary**: $60,000.00 per year

**Benefits**:

- Casual dress
- Company events
- Dental care
- Discounted or free food
- Extended health care
- On-site parking
- Paid time off
- Vision care
- Work from home

Schedule:

- 8 hour shift
- Monday to Friday

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