Job Description

Overview

Who You Are:

You are a bilingual experienced and seasoned Travel Claims professional, who is passionate about claims processing. You understand in-depth all the complexities of claims processing and policy administration. You have an investigative mind, strong adjudication and analytical skills.

The Role:

You will process health, trip cancellations and travel claims. You will be responsible for understanding all policies and act as the subject matter expert for claims processing procedures and policy administration.

Responsibilities:

·         Processes Health, Dental, Vision, Travel, Trip cancellation claims

·         Adjudicates claims according to various benefit policies

·         Handles both inbound and outbound calls to members and health providers as required

·         Provides excellent customer service for claims matters and escalations

·         Strong letter writing skills to providers, member and clients

·         Helps Claims team problem solve and uses sound judgment / discretion to proactively address and resolve problems

·         Supports Claims Team in understanding client policies, systems, workflows, issues and expectations

·         Work closely with Assistance team, Finance Team, Medical Director and other teams on day to day operations

·         Supports department initiatives that increases revenues, save costs and meet company objectives

·         Removes barriers to improve performance to enhance effectiveness and efficiency.

·         Act as a Subject Matter Expert for all claims related matters

·         Applies methods to proactively identify, monitor and intervene as required on potential high dollar/problematic claims or potentially fraudulent claims.

·         Identify claims trends and communicate to appropriate internal and external parties

·         Ensures all work in a PIPEDA and HIPAA compliant manner.

·         Other related duties as assigned

Qualifications:

·         Experience in the Travel Insurance industry is required

·         Minimum 5+ years of relevant Claims experience

·         Experience handing Legal cases.

·         High level of proficiency in Microsoft office suites

·         Superior verbal and written communication skills

·         Strong time management and organizational skills

·         Fluent in French

Assets:

·         Travel, Snowbird, Expatriate Insurance, TPA experience

·         Cost containment/provider relations experience

·         Experience with medical coding standards

·         Dispute resolutions experience

How to Apply

Insurance Career Network is a recruitment firm focused exclusively on the insurance industry.  Our relationships, knowledge and experience enable us to connect leading insurers, brokerage firm and independent adjusting firms with the most talented candidates for each role.

For consideration send your resume to jan@insurancecareernet.com or contact Jan at 416 703 5120 ext. 202

Job Categories: Adjusting. Job Types: Full-Time. Job Tags: claims, Expert, and legal.

691 total views, 1 today

Apply for this Job

Name *

Email *

Message *

Upload resumé (pdf, doc, docx, zip, txt, rtf)

Upload cover letter (pdf, doc, docx, zip, txt, rtf)