Reporting to the Claims Manager, the Claims Analyst will adjudicate and manage a fluctuating caseload of new and ongoing disability, life, critical illness claims and health claims.
You will be assessing claims and making challenging decisions by following policy guidelines which the client may challenge. You enjoy working independently and have excellent written and verbal communication skills in both French and English. Must have an understanding of medical sciences and experience in the insurance industry is required.
As a member of the Claims team, the Claims Analyst maintains an outstanding business relationship as it relates to claims with our Claimants, Key partners TPA/Brokers and other Stakeholders.
Are you someone who is passionate about providing exceptional customer service, have excellent verbal and written communication skills (English and French)? Are you looking for a role where you can work alongside a team of Claims Analysts and other members of the Division? You will work with a team who works independently and also in collaboration with one another.
In this role you will be responsible for:
Making sound adjudication of claims and ensuring you adhere to the Policies. Must be articulate in being able to provide clear explanations to our clients.
Foster a culture of openness and flexibility with TPA’s and brokers while being compliant with Privacy
Develop and maintain positive and effective business relationships with the claimant base, brokers, group policyholders; benefit administrators, reinsurers and Regional offices staff.
Participate in meetings to discuss claims services and practices, and participate in presentations put on by internal teams or external organizations
Adjudicate complex and/or contentious AD&D, Life, Disability, CI claims, including waiver of premium claims. May handle level one appeals dependent on experience. May review proposed amendments and updates being considered to claims or policy forms and provide an appropriate opinion and/or comments concerning the acceptability/adequacy of the proposed change; Will review claims with the Medical Consultants.
What we are Looking For:
-Degree in Health Sciences or Business Administration or equivalent education and experience.
-3+ years claims experience within the Group Benefits or Special Risk insurance industry, an asset
-Bilingual in English and French
-Knowledge of group life, health, accident and sickness plans and understanding of Third Party Administrators and Third Party Payors, an asset
-Strong desire to provide Superior Customer Service and relationship building skills
-Possess strong analytical skills with high attention to detail
-Ability to remain calm while being pressured to make payments quickly.
-Ability to multi-tasking and prioritize work effectively