Current jobs related to Claims Adjudicator - Canada - Robertson & Company Ltd.

*** THIS ROLE IS WITH OUR CLIENT IN THE INSURANCE INDUSTRY***

Title : Claims Adjudicator

Duration: 6 months(with possibility of extension or conversion)

Type : Remote

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.

Key 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..

Supporting the Business 20 %:

• Sound knowledge and ability to apply appropriate risk management tools and techniques.

• Actively participate in various projects that improve effectiveness and efficiency in claims practices in keeping with our culture of continuous improvement.

• Manage all issues and requirements related to the claim to achieve customer/claim resolution handing off only as appropriate.(claims adjustments, warranty investigation, technical decisions)

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

How to Apply: If you are a motivated professional looking to contribute to a leading team, please submit your resume outlining your qualifications and experience relevant to this role. Robertson & the clients we represent, value diversity and are committed to creating an inclusive workplace. We invite all qualified individuals to apply.

Robertson & the clients we represent are equal opportunity employers, committed to diversity and inclusion. Robertson is a certified diverse supplier and actively seeks to foster a representative and inclusive workforce. We welcome applications from all qualified individuals, regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, Aboriginal status, or any other legally protected factors. We champion building a diverse and inclusive environment.