Job Title: Claims Examiner
Location: Hybrid (Remote/In-office)
Type: Full-Time
About Us:
At our company, we are driven by a shared commitment to making a meaningful difference in the lives of individuals across the globe. If you're looking for an opportunity that challenges you, inspires personal growth, and allows you to be a part of a passionate team, then look no further. We believe in pushing boundaries and offering exceptional service while prioritizing the well-being of our customers.
About You:
We are looking for a motivated and self-driven Claims Examiner to join our team. With your expertise in claims processing and a strong sense of accountability, you excel in a fast-paced, high-volume environment. You understand the importance of attention to detail and consistently provide top-notch service to customers and partners alike. You have a knack for multi-tasking and problem-solving and are eager to grow within the field.
Your ability to effectively interpret policy guidelines, manage multiple claims, and communicate complex decisions with clarity will be key in delivering excellent service. You're a collaborator at heart, always ready to support your team and work towards common goals.
What You'll Do:
- Claims Processing: Handle a diverse array of claims, including medical, trip cancellation/interruption, baggage, dental, and vision, ensuring timely and accurate adjudication.
- Policy Adjudication: Evaluate claims according to benefit policies, adjusting reserves and ensuring compliance with applicable privacy and industry regulations (e.g., PIPEDA, PHIPA, and HIPAA where U.S. claims apply).
- Customer Interaction: Provide exceptional customer service via phone, email, and in-person communication, addressing inquiries, concerns, and complaints.
- Collaborate: Work alongside providers, clients, agents, brokers, and insurance carriers to resolve claims issues and share critical information.
- Documentation & Compliance: Maintain accurate and detailed records of all claims, ensuring proper documentation of each case and maintaining regulatory compliance.
- Mentorship & Support: Guide junior team members and support department goals and initiatives to ensure smooth operations.
- Continuous Learning: Stay informed on evolving industry standards and continuously improve your skills in claims processing and insurance policies.
What You Bring:
- Education: High school diploma or post-secondary degree/diploma, or equivalent experience.
- Experience: 2–3 years in travel or medical insurance claims, with a solid understanding of policy guidelines and claims management.
Skills:
- Strong analytical and critical thinking capabilities.
- Proficient in Microsoft Office and related software tools.
- Excellent verbal and written communication skills in English and French.
- Exceptional organizational and time management skills.
- Work Authorization: Legally entitled to work in Canada.
Nice-to-Have:
- Expertise in dispute resolution and claims recovery (GHIP, subrogation, coordination of benefits).
- Familiarity with insurance recovery procedures.
Pay: $19.98-$22.01 per hour
Expected hours: 35.0 per week
Benefits:
- Paid time off
- Work from home
Education:
- Secondary School (required)
Experience:
- travel or medical insurance claims: 2 years (required)
Language:
Location:
Work Location: Remote
