Claims Examiner

Job summary

The Claims Examiner is responsible for processing and adjudicating various travel insurance claims while communicating decisions to providers, members, and clients. Key duties include maintaining accurate documentation, adjusting reserves, and ensuring compliance with PIPEDA and HIPAA regulations.

Job details

Temp to Full Time Claims Examiner 100% remote Toronto or Calgary Job Overview 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 turnaround of the claim 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 accurately assess claims and inquiries. You are a very strong team player. The Claims Examiner will be responsible for processing a variety of different claims and communicating these decisions to providers, members, and clients. This role requires strong time management skills, claims experience, and policy interpretation. Responsibilities • 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, complaints, 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 in accordance with 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 Qualifications and Education Requirements • 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

What you’ll do

The Claims Examiner is responsible for processing and adjudicating various travel insurance claims while communicating decisions to providers, members, and clients. Key duties include maintaining accurate documentation, adjusting reserves, and ensuring compliance with PIPEDA and HIPAA regulations.

Requirements

Candidates must have 2-3 years of experience in travel or medical insurance claims processing and be bilingual in English and French. A high school diploma or university degree is required along with proficiency in Microsoft Office.

Listed skills

• Time management · Preferred
• Customer service · Preferred
• written communication · Preferred
• Problem solving · Preferred
• case management · Preferred
• Documentation · Preferred
• Microsoft Office · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Claims Processing
• Policy Interpretation
• Adjudication
• Customer Service
• Time Management
• Analytical Skills
• Problem Solving
• Microsoft Office
• Written Communication
• Verbal Communication
• Bilingual English/French
• Case Management
• Documentation
• Reserve Adjustment
• PIPEDA Compliance
• HIPAA Compliance

Job areas

• Finance & Accounting
• Customer Service & Support
• Administrative