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Case Manager

3 weeks ago

Toronto, Canada PlanIT Search Full time

**Job Overview**

The Case Manager will be the point of contact for members requiring both medical and non-medical assistance. You will help members find health care providers, book appointments, and make travel arrangements. You will be responsible for communicating the available benefits to members, clients, and service providers.

**Responsibilities**
- Handle medically complex cases above $10,000
- Handle high profile cases
- Escalate high dollar claims (over $10,000) to upper management and clients to assist with maximizing patient’s benefits and cost containment for the client.
- Interpret policies to provide insurance benefits and eligibility to members and health providers globally.
- Analyze insurance policies and communicate with claims and underwriting departments to make corrections to any discrepancies and inconsistencies.
- Complete adjudication of medical services to ensure claims are processed correctly facilitating timely payment.
- Redirect patients to in-network facilities and pre-negotiate future claims providing cost containment for the client.
- Document all written and verbal communication to ensure appropriate action during any customer or client complaints.
- Update clients on progress of assistance provided to their members.
- Communicate relevant information to all key stakeholders in a timely manner (clients, medical facilities, patients, families, etc.) and triage cases as per departmental policy to achieve best solutions.

**Qualifications and Education Requirements**
- Post-secondary education or related experience equivalent.
- Excellent verbal and written communication skills in English
- Minimum 5 years of customer service experience
- At least 2 years of case management experience[KP1][AA2]
- Previous experience with MS Office products such as Word and Excel
- Superior time management skills
- Resourcefulness
- Ability to work independently and within a team
- Analytical and decision-making skills
- Ability to work in a fast-paced and dynamic environment
- Insurance and policy knowledge/interpretation
- Understanding of medical terminology
- Available to work rotational shifts: days, afternoons, weekends, evenings, and public holidays

**Preferred Skills**
- Must be bilingual - English + French)[AA3]

**Additional Notes**
- This position requires availability for rotational shifts: days, evenings, weekends, and holidays; occasional overtime is required.

[KP1]Would you want this to be more than the Case Coordinator position?

[AA2]Yes 5 Customer Service and 2 Case Management

[AA3]Eng and French only

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

**Salary**: $58,000.00-$65,000.00 per year

**Benefits**:

- Casual dress
- Dental care
- Extended health care
- Paid time off
- RRSP match
- Vision care

Schedule:

- 8 hour shift
- Day shift

Supplemental pay types:

- Bonus pay
- Overtime pay

Ability to commute/relocate:

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

**Education**:

- Bachelor's Degree (preferred)

**Experience**:

- Case management: 2 years (required)
- customer service management: 5 years (required)

**Language**:

- French (required)

Work Location: One location