Claims Examiner

2 weeks ago

Ontario, Canada AppleOne Employment Services Full time

Claims Examiner Toronto (Remote)$25-27ph 6 month temp with potential to go permanent Our client is seeking an experienced Claims Examiner to join their growing team. If you have hands-on experience in claims adjudication , especially within travel or medical insurance, and you're passionate about delivering exceptional customer service, we'd love to hear from you. About the Role As a Claims Examiner, you will be responsible for reviewing, assessing, and adjudicating a variety of travel insurance claims. You will work closely with claimants, providers, industry partners, and internal teams to ensure timely, accurate, and fair claim resolutions all while maintaining compliance with regulatory standards and upholding high service expectations. Key Responsibilities Process travel insurance claims (medical, trip cancellation/interruption, baggage, dental, vision) within designated approval limits Adjudicate claims in alignment with applicable benefit policies and coverage guidelines Handle inbound/outbound calls and written correspondence, delivering exceptional customer service Collaborate with claimants, providers, agents/brokers, and other insurance carriers Work cross-functionally with internal departments to support daily operations Maintain thorough claim file documentation and adjust reserves in accordance with insurer standards Participate in file reviews, appeal discussions, and case presentations Ensure compliance with privacy regulations including PIPEDA and HIPAA Mentor team members and support departmental projects and initiatives Required Qualifications High school diploma or post-secondary education 2–3 years of experience in travel or medical insurance claims processing preferred Bilingual in English/French Asset Strong analytical and problem-solving skills Proficiency in Microsoft Office Suite Excellent verbal and written communication abilities Effective time management and strong organizational skills Preferred Experience Background in snowbird, expatriate insurance, or third-party administration (TPA) Experience handling Canadian and U.S. medical invoices/claims Knowledge of dispute resolution processes Familiarity with GHIP recovery, coordination of benefits, or subrogation Disclaimer: This is currently for an active job opportunity . By applying, you will be part of our trusted network, ensuring our recruiters match you with suitable roles. Let us help you take the next step in your career journey

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