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Claims Examiner
2 weeks ago
Claims Examiner/Adjuster
Cambridge, ON (On-site)
6-month contract
Review, examine, calculate and make decisions on a variety of claims in accordance with applicable policy and service standards. Required to attain performance objectives on a monthly basis.
- Reviewing, examining, calculating, and making decisions on a variety of claims received in the claims processing unit, to ensure the claim is paid under the respective policy and within the contracted timeframes.
- Conducting research via policies/flipcharts that can provide additional information needed to adjudicate claims.
- Entering notes into the computer system/databases as required.
- Facilitating stop payment requests and processing reissues accordingly.
- Placing outbound calls to customers or providers to obtain information required to adjudicate a claim.
- Creating and sending various types of professional correspondence.
- Responding to inter-departmental inquiries.
- Responding to escalations in a timely manner.
Qualifications:
- Post-secondary education
- Minimum of 6-12 months experience as a Claims Examiner or similar role.
- Ability to pay close attention to detail and multi-task.
- Possess sound judgment and good decision-making skills.
- Fluency in French is preferred.
