Claims Assessor Jobs in Windsor, Ontario, Canada
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Windsor, Ontario, Canada
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About the role
Job Description
Are you a people person with a knack for providing excellent customer service? Are you interested in working in a multilingual and friendly environment that encourages personal and professional development? We would love to meet you! As a Claims Assessor, you’ll be evaluating and enforcing 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? Review applicable policy wording and validate claim coverage; Review all verbal and written communication within the file; Review bills for rendered services, coding, and reasonable & customary charges; Review medical information submitted for necessity of further requirements or internal specialist review; Establish presence of claim requirements as per policy wording (i.e.: proof of payment and authenticity of bills/claims); Request missing claim components as required for adjudication; Ensure creation of appropriate follow up workflows; Provide notice of claim decision and explanation including denials via phone, formal letter, or email; Confirm and adjust (if required) claim entries. What skills and training do you need? A University degree or college diploma preferred, but not required; Experience in insurance product benefits and limitations an advantage; Comprehension of healthcare system and billing practices an advantage; Proficiency in Microsoft Office suite; Bilingualism (French and English) is mandatory. Excellent written and verbal communication skills in both languages are required to review claims and client communications, primarily from outside Canada, and to collaborate effectively with teams across multiple locations. Excellent organizational skills with a strong attention to detail and strong decision-making skills; Ability to adapt to on-going change and work volumes in a fast-paced, customer focused environment.
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.
Ontario Candidates : Starting at 22.56$/hour (+ Bilingual Premium if applicable)
Québec Candidates : Starting at 22.56$/hour (+ Bilingual Premium if applicable) To get a taste of the Global Excel life and for more information on our company, visit our Facebook page and website:
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About Global Excel Management Inc.
Global Excel is a full-service provider of global healthcare risk management solutions. Global Excel, together with its subsidiaries based in Canada, USA, Mexico, Europe, Africa, and Asia, offers a complete range of risk mitigation, cost containment, claims management and medical assistance services to over 1800 clients located in more than 90 countries around the world. As a group, Global Excel will manage approximately 420,000 inpatient, outpatient and non-medical cases per year and processes in excess of $1.95B USD in healthcare claims annually.
The Global Excel family encompasses over 1500 employees internationally located in Sherbrooke, Canada, in Windsor, Canada, Miami, USA, Mexico City, Mexico, Europe and Africa, as well as Jakarta, Indonesia.
Gestion Global Excel Inc. est un fournisseur de solutions globales complètes dans la gestion des risques associés aux soins de santé. Global Excel et ses filiales, dont les bureaux se situent au Canada, aux États-Unis, au Mexique, en Europe, en Afrique et en Asie, offrent une gamme complète de services d’atténuation des risques, de contrôle des coûts, de gestion des réclamations et de services d’assistance médicale à plus de 366 clients répartis dans plus de 90 pays à travers le monde. En tant que groupe, Global Excel gère près de 360 000 cas médicaux et non médicaux annuellement, et ce, en milieu hospitalier et en consultation externe. Notre entreprise traite plus de 1,9 milliard de dollars US en réclamations associées aux soins de santé par an.
La famille Global Excel emploie plus de 900 employés aux quatre coins du monde situés à Sherbrooke, Canada; à Windsor, Canada; à Miami, États-Unis; à Mexico, Mexique; en Europe; en Afrique ainsi qu'à Jakarta, Indonésie.