Bilingual Claims Adjudicator
6 days ago
Career Opportunity
Role Title
Bilingual Claims Adjudicator
Purpose of role
As a Member of the Claims team, the incumbent will be accountable for ensuring that all claims are adjudicated and administered according to state and provincial law and regulations and, in a fair, ethical and efficient manner.
Job Description
Key Responsibilities
- Adjudicate various types of complex claims, including Life, Critical Illness, Disability, Member Ship Benefits and Accelerated Death Benefit claims. This includes identifying, collecting and reviewing all relevant information needed to determine the claim legitimacy and eligibility as well as the benefit amount payable.
- Familiarization with the requirements of the appropriate provincial/state legislation and/or regulations related to the type of claim being reviewed.
- Perform all necessary benefit calculations and ensure all related activities are in compliance with provincial/state statutory and internal standards.
- Communicate effectively both verbally and written with outside resources such as but not limited to medical consultants, legal consultants, independent physicians, coroners, police or investigative services.
- Determine which claims need to be referred for evaluation and decision, based on authority limits, business case issues or referral to legal counsel.
- Maintain and update system records as necessary.
Key Qualifications
- Education (minimum required): College Diploma or University Degree an asset
- Experience (minimum required): 3-4 years’ experience adjudicating life insurance and living benefit claims.
- Bilingual (French) required
- Knowledge of claims adjudication theory, principles, methods, systems, processes and standards including an understanding of insurance medicine and actuarial principles/methods as they relate to the claims function.
- Self-starter with demonstrated ability to prioritize case load and ability to research/problem solve and make decisions both independently and collaboratively within a fast-paced team environment
- Advanced verbal and written communication skills to effectively communicate with internal and external customers/partners and vendors.
- Strong reasoning and judgment to balance commitments, financial soundness and quality customer focus
- Strong analytical skills for research, review and assessment of claims.
- LOMA/ALHC designation an asset
LI-Hybrid
Equal Opportunity Employment and Inclusion - _at Foresters Financial, we are committed to sustaining an equal opportunity environment for all job applicants. We embrace Inclusion, Diversity and Equity (IDE) as a core strategic objective for building strong, innovative teams in which all our employees can show up wholly and authentically as themselves._
- in advance of your appointment._
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