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Claims Adjudicator I
2 months ago
Job Summary:
The Claims Adjudicator is accountable for handling claims in accordance with high service standards to meet or surpass client expectations. The Adjudicator is required to make a number of determinations that may affect the member's entitlement to benefits and/or the amount of benefits that are payable. The Adjudicator reviews claims for completeness, enters and assesses claims, and produces the final statement and/or payment responsibility, after the member's insurance benefits are applied to a claim. The Adjudicator will be required to contact various practitioners or service providers to obtain clarification on claim information as necessary.
Individual Accountabilities:
Claims Adjudication 80%:
• Assesses highly complex health/dental claims in keeping with contract provisions, taking initiative and ensuring that empowered decision making is a key component of the process.
• Assume ownership of the claims assigned with an understanding of the urgency of specific cases and effectively prioritize work accordingly.
• Establish and maintain quality customer service within our turnaround times using influence with internal and external clients to meet all pre-established service standards in order to delight our customers..
Job Requirements:
• Post-secondary education or equivalent experience
• Strong customer service focus and the ability to take the initiative
• Previous claims adjudication and/or relevant insurance or health care industry experience a definite asset
• Strong working knowledge of Microsoft Office 365 suite of programs
• Detail oriented with quick assessment skills
• Excellent interpersonal skills and the ability to interact and work with others at all levels to achieve customer resolution
• Superior communication skills (verbal and written) for a variety of internal and external audiences (Both in English and French as applicable)
• The ability to work effectively as an individual and as part of a team in a fast-paced environment
