POSITION

SALARY

INDUSTRY

LOCATION

TYPE

REF #

Level III Claims Examiner: Accident and Health

OPEN

Insurance

Toronto

Permanent

807001C

POSITION DESCRIPTION

Adjudicate new and existing claims which involves:

• Detailed review of new claims with turnaround time average of three working days

• Detailed medical reviews

• Coordination of review with the medical consultant team

• Detailed telephone interviews with employers and claimants

• Assessment of information received

• Making claims decisions to approve or deny benefits in accordance with the terms and conditions of the policy

• Contact with key employer contacts

• Production of quarterly financial reports

• Release of payments on approved claims

• Documenting rationale and actions in claims records

• Coordination of independent assessments, field visits, and rehabilitation activity as appropriate

REQUIREMENTS

• Minimum 7-10 years’ experience in the Accident & Health insurance product environment (AD&D, Travel (emergency medical) Insurance, Critical Illness, In Hospital Cash, Weekly Accident Insurance), including focus on quick turnaround service standards, detailed telephone interviews and functional case management, short term disability claim management experience is necessary.

• Fluently bilingual (English/French) would be an asset

• Demonstrated experience in partnering with clients

• Excellent oral and written communication skills

• Excellent organizational, interpersonal and customer service skills

• Ability to multi-task and work effectively in a fast paced team environment

• Ability to manage work load effectively, especially during times of high activity

• Confident knowledge of systems and PC applications (Windows, MSWord, and Excel)