Claims Examiners

3 hours ago

Montréal, Canada soNomad Full time

**Job Summary**:
**Key Responsibilities**:

- Review and analyze insurance claims to determine validity, accuracy, and eligibility based on policy guidelines and medical documentation.
- Investigate complex claims by collaborating with healthcare providers, policyholders, and other stakeholders to gather additional information as needed.
- Ensure compliance with company policies, industry regulations, and legal standards in claims processing.
- Provide clear and concise explanations for claim approvals, denials, or adjustments to internal teams and claimants.
- Maintain accurate records and documentation of all claim decisions and communications.
- Identify potential fraud or abuse patterns in claims and escalate issues for further review.
- Assist in training or mentoring team members on medical-related claim inquiries as needed.

**Qualifications**:
Education: Registered Nurse (RN) or equivalent nursing certification required; bachelor’s degree in nursing or a related field preferred.

Experience: Minimum of 5 years of experience in the assistance industry (assistance company or medical claims processing).

Medical Knowledge: Strong understanding of medical terminology, anatomy, physiology, and standard healthcare practices.

**Skills**:
Excellent analytical and problem-solving abilities.

Proficiency in reviewing medical records and interpreting clinical data.

Strong attention to detail and organizational skills.

Effective communication skills, both written and verbal, to interact with claimants and healthcare professionals.

Familiarity with insurance policies, claims processing systems, and regulatory compliance.

Technical Proficiency: Comfortable using claims management software and standard office tools.

Certifications: Additional certifications in medical coding, billing, or insurance claims are a plus.

**Preferred Attributes**:
Prior experience as a claim examiner or in a similar role within the insurance industry.

Ability to work independently and manage multiple priorities in a fast-paced environment.

Commitment to maintaining confidentiality and handling sensitive information with integrity.

**Work Environment**:
Full-time position, remote work.

Collaborative team setting with opportunities for professional growth and development.

**Salary & Benefits**:
Competitive salary commensurate with experience.

Comprehensive benefits package including health insurance, personal days off and paid time off.

**Benefits**:

- Extended health care

Work Location: Remote

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