Job Description:

This position exists to evaluate and enforce claim benefits and limitations based on a comprehensive understanding of the applicable policy wording. The claims assessor is responsible for qualifying a claim/bill for payment. Claims are reviewed for customer service and may require direct client contact. The assessors are responsible to contribute to cost containment efforts by validating bills for services rendered, authenticity and reasonable and customary charges.

What does your typical day look like?

• Validate claim coverage;
• Confirm clean bill components are present;
• Review all verbal and written communication within the file;
• Review applicable policy wording;
• Review bills for rendered services, coding and reasonable & customary charges;
• Ensure bills are directed to the appropriate internal financial process;
• Claims are reviewed with precision for compliance with expressed client directives (as applicable);
• Establish presence of claim requirements as per policy wording (i.e.: proof of payment and authenticity of bills/claims);
• Review medical information submitted for necessity of further requirements or internal specialist review;
• Research and confirm global claim influences (i.e. travel advisories);
• Request missing claim components as required for adjudication;
• Ensure creation of appropriate follow up workflows;
• Clarify and explain denials if required;
• Provide notice of claim decision via email, phone or formal letter;
• Confirm and adjust (if required) claim entries;
• Apply limitations in GEM systems;
• Confirm process conformity pre and post assessment.

Major Challenges

• Volume & complexity of products;
• Complexity of process;
• Changes in work volume due to seasonality and unexpected global events.

Major Job Accountabilities

• Accuracy – Claim decisions and payment amounts; provide accurate information to claimants;
• Quality – High level of satisfaction from internal and external customers;
• Efficiency – managing your work as per your productivity guidelines. Claims are processed accurately and efficiently;
• Adherence and Absenteeism – adhering to your work schedule.

Success Measures

• Client specific turnaround times (TAT) are met or exceeded;
• Meeting or exceeding your quality targets;
• Meeting or exceeding your productivity targets.

What skills and training do you need?

• College diploma or equivalent;
• One to two years of experience in a customer service-related position;
• Available to work daytime schedule. Evenings and weekends may be requested with appropriate notice;
• Clear and effective communication in English or French (written and verbal); other languages such as Spanish are an asset. English is required in order to review claims and other communications, written or oral, from clients located mostly outside Quebec; as well as to work closely with teams from our Windsor, Ontario site;
• Knowledge of insurance product benefits and limitations;
• Knowledge of system processes and workflows;
• Comprehension of healthcare systems and billing practices;
• Strong decision-making skills;
• Attention to detail;
• Excellent verbal and written communication;
• Good organizational skill and ability to prioritize;
• Proficiency in the Microsoft suite products.

When you apply:

If you require assistance or accommodation during our recruitment process, please notify Human Resources so that we can review and consider how we may be able to assist you based on your individual needs.

We offer you:

• Global Excel offers more than a position;
• We offer a competitive compensation package that includes a base salary, performance bonus and an extensive benefits package;
• A professional future with opportunities for development, growth, and advancement;
• RRSP Match program;
• Financial assistance to employees who wish to continue their education;
• Work/life balance, health and wellness initiatives including an excellent EAP program;
• Employee engagement programs that focus on fitness, food, and fun;
• Windsor, Ontario Candidates: base hourly salary scale ($19.55/hour - $25.66/hour ). Relevant candidate experience considered;
• Other locations, salary to be discussed based on geographic differential.

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