Medical Case Manager
- Employer: iA Financial Group
- Office: 2200, McGill College Avenue
- City: Montreal
- Province: Quebec
- Job category: Customer Service and Administrative Support
- Job ID: JR10004751
- Job type: Permanent Job Full time
iA Financial Group is the fourth largest life and health insurance company in Canada and offers a wide range of products for all stages of life and to meet the needs of clients across its vast sales network. Founded in 1892, iA Financial Group’s stability and solidity make it an employer of choice that invests in its employees and their development over the long term.
With operations across Canada and in the United States, iA Financial Group and its over 5,000 employees work hard every day to offer the best service to over four million clients.
We are looking to hire a medical case manager for our Group Health and Dental Claims team in Montreal.
You will develop and manage the approach to and management of medical cases at iA Financial Group. Your expertise in nursing will help you to take charge of the processing of medical care claims that require a medical assessment or drug claims that require prior approval. Join our team now!
Specifically, you will:
- Be in charge of assessing complex and costly claims including:
- Prescription drugs requiring prior authorization drug claim
- Home care costs, hospitalization costs, medical equipment
- Disabled dependents, etc.
- Do a detailed analysis of files of major claimants in order to identify elements requiring special attention.
- Recommend interventions (e.g., prevention programs, medication review, etc.).
- Prepare summary reports upon request for specific groups in order to demonstrate the work being done and the beneficial effects of our file reviews.
- Communicate with various stakeholders, including insureds, health care professionals, pharmacists, and contract administrators in order to obtain information required to review files or to explain decisions.
- Draft required correspondence, as needed, and code the system to document files.
- Identify any follow-ups to be done and make sure deadlines are met.
- Actively and professionally manage claims while respecting service times in accordance with the standards in place and guaranteeing high quality.
- Contribute to the development and keeping of the documentation relating to the various processes.
- Stay up-to-date on new treatments and pharmacotherapies.
- Work closely with internal specialists (e.g., physicians, pharmacists, investigation team, etc.).
- Provide support to the group insurance team in respect of complex medical matters.
- Contribute to the auditing of claims requiring prior authorization or a medical assessment.
- Attend meets with clients, on occasion.
- Contribute to projecting a positive image of iA to clients and suppliers.
- Perform any other duties as needed in order to achieve the team’s objectives.
- Diploma of college studies or bachelor’s degree in nursing or a related health-care field
- Minimum of three to four years of relevant work experience
- Must be bilingual
- Customer service and teamwork abilities
- Excellent oral and written communication skills
- Excellent judgment, and excellent analytical and synthesis skills
- Positive attitude, leadership and infectious enthusiasm
- Ability to travel occasionally
- Availability and flexibility to work occasional overtime
iA Financial Group is committed to having an equal access employment program and welcomes applications from women, visible minorities, Aboriginal peoples and disabled persons. Any use of the masculine form is to simplify the text and includes the feminine form.
Also, we are committed to fostering a workplace that promotes diversity and inclusion. We can provide accommodation in our recruitment and selection processes to applicants with disabilities where required. Please contact your Recruiter, or send an email to email@example.com.