Claims Assistant
3 weeks ago
Claims Examiner
Hamilton
SUMMARY OF JOB FUNCTIONS:
RESPONSIBILITIES:
Sets-up new claims in claim system and validates coverage, accurate claim coding, and adequate reserving.
Reviews claim submissions and determines if any documentation is outstanding
Requests and gathers outstanding documentation and adds the information to claim files; prepares completed claim files and then refers files to assigned Claims Examiners for review and adjudication.
Updates claims database as appropriate
Reviews and actions outstanding task lists and other reports as required.
Interacts with a variety of individuals including claimants, agents, business partners, hospitals, doctors and lawyers.
Multitasks caseloads, emails, phone calls and reporting.
QUALIFICATIONS:
Education/ Experience:
Post secondary diploma or related insurance studies/designation, or equivalent related work experience
Skills/Abilities:
Excellent attention to detail and organizational skills.
Excellent verbal and written communication skills; ability to interact with a variety of people in a positive and professional manner.
Strong time management skills.
Ability to accept direction but also to take initiative on tasks.
Ability to work independently as well as part of a team.
Ability to maintain confidentiality in all matters.
Customer-service oriented.
Ability to work and handle pressure in a fast-paced high-volume environment.
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