Medical Claims Processor

Epic Health Solutions boasts over 35 years of experience in the healthcare industry, providing innovative solutions in an ever-evolving marketplace. We are seeking a detail-oriented, bilingual Claims Examiner to join our Travel Insurance team at Epic Health Solutions. In this role, you will review, investigate, and adjudicate travel insurance claims while communicating professionally with insureds, brokers, and medical facilities in both English and Portuguese. This position is essential to maintaining claims accuracy and supporting our operational goals. Review, investigate, and adjudicate Travel Insurance claims (Medical, Trip Cancellation/Interruption/Delay, Baggage Loss/Damage/Delay) in accordance with policy terms and conditions Communicate effectively and professionally in both English and Portuguese with insureds, agents/brokers, medical facilities, and other stakeholders to collect documentation and explain claim status and decisions Analyze medical records and other supporting evidence to determine coverage and validity of claims Respond to claim inquiries and complaints from insureds and brokers in a timely, courteous manner Maintain accurate reserves and ensure timely updates to the claims management system Draft clear, accurate, and compliant claim denial letters that cite applicable policy language, in both English and Portuguese as needed Participate in quality reviews, training, and continuous improvement initiatives 2-3 years of experience in claims examining or adjusting insurance claims (Travel, Health, or related field) ~ Bilingual fluency in English and Portuguese (spoken and written) required; must be able to professionally read, write, and speak with agents, medical facilities, and brokers in both languages ~ Strong understanding of travel insurance policies and benefits considered an asset ~ Proficiency with MS Office Claims Adjudication
· Customer Service Excellence
· Accuracy and Attention to Detail
· Communication
· Time Management
· Accountability
· Problem Solving
· Teamwork
· Professionalism Full-time 8-hour shift, Day shift, Monday to Friday Language Requirements English and Portuguese Dental care Employee assistance program Life insurance On-site parking Epic Health Solutions is committed to providing an inclusive and accessible work environment and complies with the Accessibility for Ontarians with Disabilities Act (AODA).