Travel Medical Claims Adjudicator

7 days ago

Thornhill, Canada CAA Club Group Full time

**About Us**:
At Orion Travel Insurance, we are passionate about helping our customers travel with confidence in the event that they require medical assistance. We require high performing, forward thinking, and innovative people who work collaboratively to keep propelling our business forward.

**Who we are**:
As Canada's largest automobile association, we are passionate about keeping our Members safe
- whether they are on the road, at home, or travelling abroad. Meeting the diverse needs of our two-million Members requires high performing, forward thinking, and innovative people who work collaboratively to keep propelling our business forward. Life at CAA Club Group is fast paced, performance-driven and rewarding. We value our Associates' career growth and ongoing professional development
- and we regularly recognize their achievements and outstanding results. CAA Club Group (CCG) is known for providing stellar emergency roadside assistance to our motoring Members and non-Members. We work hard and play hard. We're about doing what's right and feeling good about it.

**Position Details**:
**What** **You** **Will** **Do**

Reporting to the Manager, Orion Claims and Assistance, Travel Medical Claims Adjudicator will drive the following:

- Handles files escalated by TPA for denial recommendation
- Escalate all denied claims to the corresponding Club for Ex-Gratia consideration
- Provide back-up and assistance to Medical Claims Adjusters with large loss medical claims as needed
- Responds to general inquiries from associates or clients regarding policy coverage or claim procedures
- Liaises with Helpdesk in answering claim related questions, assisting in interpreting policy questions
- Responds to and manages direct complaints to resolution, adhering to internal standards and compliance with regulatory bodies
- Communicates claim action/processing with claimant, client, or associate
- Investigates, identifies and documents procedural, system or product weaknesses that are detected as a result of customer complaints and recommends and/or initiates corrective actions
- Coordinates with the Ombudsperson to ensure full file disclosure and provides assistance as required
- Reports ResponseTek and QA results to claims manager on a monthly basis, or as requested

**What You Have**
- Post-secondary education completion, preferably a University degree in the field of Health Studies or Nursing is preferred
- Knowledge of or previous experience with the claims handling process, preferably in the travel, health, or P&C insurance industry
- Knowledge of medical terminology and conditions is a strong asset
- Flexibility to work outside of Ontario business hours, to coincide with British Columbia business hours may be required on occasion
- Excellent communication skills, both written and verbal
- Fluency in the English and French is preferred
- Strong customer service skills
- Excellent negotiation skills
- Strong analytical and decision-making skills
- Ability to work well both independently and in a team environment

**Our Commitment**:

- We are an equal opportunity employer and are committed to providing employment accommodation. Orion will provide accommodations to job applicants with disabilities throughout the recruitment process. If you require an accommodation, please notify us and we will work with you to meet your needs._

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