Claims Assessor (15-month term, In-Office)
About the role
At GMS, we've been helping Canadians for more than 75 years to get the health and travel insurance they want and need. The same pioneering spirit that started our story is what drives us to do things differently today. Insurance, honestly, is our promise, and it's what we do at GMS. We care about our customers, our community and each other. As a non-profit organization, we're proud to reinvest our profits into the health of the communities we serve and that have supported us since 1949.
We want our employees to feel good about coming to work and being in a workplace that promotes flexibility, growth and a healthy work-life balance. If you'd like to be part of a team that truly takes care of our customers, our communities, and each other, this could be your chance.
Here's the role
The Claims Assessor is responsible for adjudicating and processing claims submitted through multiple mediums. This involves reviewing receipts and applying attention to detail to ensure the claim is processed accurately and efficiently. The Claims Assessor will directly communicate with clients and providers through phone calls or written correspondence to ensure claims payments are processed within the standard turnaround times. They work closely with the Customer Care department providing advice and guidance as required.
Position Responsibilities
- Adjudicate individual and group customers health and pharmacy claims based on their policy provisions.
- Process claim transactions with accuracy while meeting turnaround times.
- Continuously update knowledge of health and pharmacy benefit standards and procedures.
- Identify and investigate unusual (potentially fraudulent) claims and look for ways to improve adjudication practices and customer experience.
- Understand Co-ordination of Benefits guidelines, apply guidelines to adjudication process and ensure co-ordination of benefits information is correct and updated in the system.
- Investigate customer concerns with regards to claim payments.
- Serve as a back-up for dental claim review and processing.
- Support projects and user acceptance testing as required.
- Liaise with our Assistance partner where necessary.
Competencies
- Quality Orientation: Completes tasks with a high level of accuracy; routinely checks inputs, outputs, tasks, and processes to ensure they are error free.
- Communication: Communicates clearly and concisely both in writing and verbal conversations; listens to others and responds accurately to meet the needs of the customer or client by accurately interpreting tone of voice and body language.
- Customer Focus: Ability to listen and understand key needs, motivations, and nonverbal expectations of customers, and provide solutions that address each customer's unique situation.
- Analytical Thinking: Applies structured thinking to interpret data and identify patterns. Breaks down information from multiple sources into manageable components using a step-by-step approach to solve problems.
EducationExperience
- High school diploma required, (college certificate, university degree an asset) or combination of education and work experience.
- One to three years insurance experience, medical office experience, or financial services Industry experience is an asset.
- Medical terminology is an asset.
- An understanding of MS Office.
Are we a fit?
If you think so, please apply by September 18, 2025. We'd love to reach out to everyone who applies, but we just don't have enough hands! If you're selected for an interview, we'll be in touch. If not, please consider us again in the future.
Claims Assessor (15-month term, In-Office)
About the role
At GMS, we've been helping Canadians for more than 75 years to get the health and travel insurance they want and need. The same pioneering spirit that started our story is what drives us to do things differently today. Insurance, honestly, is our promise, and it's what we do at GMS. We care about our customers, our community and each other. As a non-profit organization, we're proud to reinvest our profits into the health of the communities we serve and that have supported us since 1949.
We want our employees to feel good about coming to work and being in a workplace that promotes flexibility, growth and a healthy work-life balance. If you'd like to be part of a team that truly takes care of our customers, our communities, and each other, this could be your chance.
Here's the role
The Claims Assessor is responsible for adjudicating and processing claims submitted through multiple mediums. This involves reviewing receipts and applying attention to detail to ensure the claim is processed accurately and efficiently. The Claims Assessor will directly communicate with clients and providers through phone calls or written correspondence to ensure claims payments are processed within the standard turnaround times. They work closely with the Customer Care department providing advice and guidance as required.
Position Responsibilities
- Adjudicate individual and group customers health and pharmacy claims based on their policy provisions.
- Process claim transactions with accuracy while meeting turnaround times.
- Continuously update knowledge of health and pharmacy benefit standards and procedures.
- Identify and investigate unusual (potentially fraudulent) claims and look for ways to improve adjudication practices and customer experience.
- Understand Co-ordination of Benefits guidelines, apply guidelines to adjudication process and ensure co-ordination of benefits information is correct and updated in the system.
- Investigate customer concerns with regards to claim payments.
- Serve as a back-up for dental claim review and processing.
- Support projects and user acceptance testing as required.
- Liaise with our Assistance partner where necessary.
Competencies
- Quality Orientation: Completes tasks with a high level of accuracy; routinely checks inputs, outputs, tasks, and processes to ensure they are error free.
- Communication: Communicates clearly and concisely both in writing and verbal conversations; listens to others and responds accurately to meet the needs of the customer or client by accurately interpreting tone of voice and body language.
- Customer Focus: Ability to listen and understand key needs, motivations, and nonverbal expectations of customers, and provide solutions that address each customer's unique situation.
- Analytical Thinking: Applies structured thinking to interpret data and identify patterns. Breaks down information from multiple sources into manageable components using a step-by-step approach to solve problems.
EducationExperience
- High school diploma required, (college certificate, university degree an asset) or combination of education and work experience.
- One to three years insurance experience, medical office experience, or financial services Industry experience is an asset.
- Medical terminology is an asset.
- An understanding of MS Office.
Are we a fit?
If you think so, please apply by September 18, 2025. We'd love to reach out to everyone who applies, but we just don't have enough hands! If you're selected for an interview, we'll be in touch. If not, please consider us again in the future.