Claims Examiner

Job summary

Process and adjudicate travel insurance claims, including medical, trip cancellation or interruption, baggage, dental, and vision claims, while communicating decisions and providing customer service. Maintain accurate claim files, adjust reserves, collaborate with internal and external stakeholders, participate in reviews and appeals, and ensure compliance with PIPEDA and HIPAA.

Job details

At MSH, passion meets profession. We're a team of dedicated enthusiasts who find genuine fulfillment in what we do — and we're looking for someone who feels the same way. About You You are an experienced Claims Examiner who can handle a large case load, multi-task, and meet tight deadlines. You thrive in a fast-paced environment providing excellent customer service in both the claim turnaround and handling emails and incoming calls. You will have the desire to develop an in-depth understanding of this position and be able to easily maneuver through numerous policies to assess claims and inquiries accurately. You are a strong team player. You will be responsible for processing a variety of different claims and communicating these decisions to providers, members, and clients. You have strong time management skills, claims experience, and policy interpretation. In This Role, You’ll Get To Experience Process travel insurance claims for medical, trip cancellation/interruption, baggage, dental, and vision claims up to the designated limit. Adjudicate claims according to various benefit policies Handle both inbound and outbound calls, and complaints, and provide excellent customer service for claims matters both in person and via written correspondence Work closely with claimants, providers, agents, brokers, other insurance carriers, or their representatives Work closely with other departments within the company on a day-to-day basis Maintain accurate documentation on all claim files Adjust reserves following the insurer’s guidelines Present cases and participate in discussions during file reviews and appeals Ensure all work complies with the PIPEDA and HIPAA Support department initiatives and objectives Provide guidance and mentorship to peers Other related duties as assigned What You Bring High school diploma or University Degree or equivalent Minimum 2-3 years of relevant travel insurance or medical insurance claims processing experience Bilingual: English/French is required Strong analytical and problem-solving skills High level of proficiency in Microsoft Office suites Superior verbal and written communication skills in English and/or French Strong time management and organizational skills Must successfully apply for Alberta Adjuster License within one month of hire What do you need to succeed? Snowbird, expatriate insurance, TPA experience Experience in handling Canadian and US medical invoices/claims Dispute resolutions experience GHIP recovery/coordination of benefits/subrogation Solid Team Player What's In It for You Salary Range: 48-52k CAD annually + Variable Bonus (Final compensation will reflect the candidate's experience, skills, and qualifications) Flexible hybrid work setup Comprehensive health benefits Employee assistance program Wellness spending account RRSP matching Minimum 3 weeks vacation (plus generous sick and flex days) Tuition reimbursement Real opportunities for growth and skill development Inclusive, diverse workplace culture Leadership that genuinely cares about your success and well-being Clear paths for both vertical and horizontal career growth MSH is an equal opportunity employer committed to fostering an inclusive, barrier-free recruitment process. We welcome applications from all qualified individuals regardless of race, ancestry, colour, ethnic origin, citizenship, creed, sex, sexual orientation, gender identity or expression, age, record of offences, marital status, family status, or disability. If you require accommodation at any stage of the recruitment process, please reach out. We will work with you in accordance with the Ontario Human Rights Code and the Accessibility for Ontarians with Disabilities Act (AODA). We thank all applicants for their interest. Only those selected for an interview will be contacted. In accordance with Ontario's Working for Workers Four Act, 2024, MSH confirms that artificial intelligence tools may be used in the recruitment and selection process for this position

What you’ll do

Process and adjudicate travel insurance claims, including medical, trip cancellation or interruption, baggage, dental, and vision claims, while communicating decisions and providing customer service. Maintain accurate claim files, adjust reserves, collaborate with internal and external stakeholders, participate in reviews and appeals, and ensure compliance with PIPEDA and HIPAA.

Requirements

Applicants need a high school diploma, university degree, or equivalent, at least 2–3 years of relevant travel or medical insurance claims processing experience, and English-French bilingual ability. Strong analytical, communication, organizational, and time-management skills are required, along with Microsoft Office proficiency and the ability to obtain an Alberta Adjuster License within one month of hire.

Benefits

• Flexible Hybrid Work Setup
• Comprehensive Health Benefits
• Employee Assistance Program
• Wellness Spending Account
• RRSP Matching
• Minimum Three Weeks of Vacation
• Sick Days
• Flexible Days
• Tuition Reimbursement
• Growth and Skill Development Opportunities

Listed skills

• Customer service · Preferred
• Problem solving · Preferred
• Time management · Preferred
• Organization · Preferred
• written communication · Preferred
• Microsoft Office · Preferred
• Teamwork · Preferred
• Mentorship · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Travel Insurance Claims Processing
• Medical Insurance Claims Processing
• Claims Adjudication
• Policy Interpretation
• Customer Service
• Analytical Skills
• Problem-Solving
• Time Management
• Organization
• Verbal Communication
• Written Communication
• Microsoft Office
• Dispute Resolution
• Teamwork
• Mentorship
• Bilingual English and French

Job areas

• Finance & Accounting
• Customer Service & Support
• Healthcare

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