Claims Examiner

2 weeks ago

Toronto, Ontario, Canada MSH International (Canada) Ltd. Full time $60,000 - $90,000 per year

It's fun to work in a company where passion meets profession, and every team member is not just an employee but a dedicated enthusiast, making the work journey truly enjoyable and fulfilling

About Us:

We are seeking ambitious individuals who share our values and our passion for making a positive impact on people's lives around the world. If you are looking for a career that challenges and inspires you, you've come to the right place.

About You

You are an experienced Claims Examiner skilled at Excel, can handle a large claims load, multi-task, and meet tight deadlines. You thrive in a fast-paced environment providing excellent customer service in both the turnaround of the claim and handling emails and incoming calls. You will have the desire to develop an in-depth understanding of this position and be able to easily maneuver through assessing claims and inquiries. You are a very strong team player.

The Claims Examiner will be responsible for processing a variety of different claims and communicating

these decisions to providers and clients. This role requires strong time management skills,

claims experience, and strong Excel skills.

In this role, you'll get to experience:

  • Process EU and UK health, dental, and pharmacy claims

  • Adjudicate claims based on approved Letter of Guarantee periods for the client

  • Provide excellent customer service for claims matters both verbal and written

correspondence

  • Handle both inbound and outbound calls to EU/UK health providers as required

  • Ensure all work complies with the PIPEDA and GDPR

  • Reconciliation of claims with Healthcare providers

  • Data Entry is required to key in scanned claims/invoices into the V9 system

  • Maintain concise file documentation consistent with corporate policies

  • Provide overall portfolio management of assigned claims files

  • Provide guidance and mentorship to peers

  • courier/mail management

  • Other related duties as assigned

What you bring:

  • High school diploma or equivalent

Required Skills

  • Experience in the EU/UK health insurance industry is required

  • Minimum 2-3 years of claims processing experience

  • Experience in processing health, dental, and pharmacy claims

  • High level of proficiency in Microsoft Office suites, specifically Excel

  • Superior verbal and written communication skills

  • Strong time management and organizational skills

  • Strong analytical and problem-solving skills

What do you need to succeed?

  • Cost containment/provider relations experience

  • Proficiency in Arabic, German, and French language is a plus.

  • Experience with medical coding standards

  • Dispute resolutions experience

Additional Notes

  • The hours for this position are 9 am-5pm EST from Monday through Friday. Occasional overtime on evenings and weekends is required.

What's in it for you:

  • Hybrid work environment
  • Excellent health benefits
  • Employee assistance program
  • Wellness account
  • RRSP matching
  • Minimum 3 weeks' vacation
  • Generous amount of sick and flex days
  • Tuition reimbursement program
  • Opportunities to learn new skills, grow, and move into different roles
  • A work environment that embraces diversity and promotes inclusivity.
  • Supportive leadership prioritizes your success and cares about your well-being.
  • A growth trajectory designed to expand vertically and horizontally, providing opportunities to pursue your passions and acquire new skills.

Job Type: Full-time

Benefits:

  • Company events
  • Dental care
  • Disability insurance
  • Employee assistance program
  • Extended health care
  • Flexible schedule
  • On-site parking
  • Paid time off
  • RRSP match
  • Tuition reimbursement
  • Vision care
  • Wellness program

Work Location: Hybrid remote in Toronto, ON M5H 1J9

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