Full-Time Claims Examiner
Job Description
Our Client is dedicated to International Corporations, Institutions and Global Organizations, Insurers and Health Carriers. They provide worldwide Remote Medical & Security Services, Business Travel Risk Management and International TPA & Cost Containment Services.
1. ACCOUNTABILITY OBJECTIVE
• Accountable for the efficient and accurate adjudication and processing of international and domestic US claims as per the terms and conditions of the policy within the established company
protocols and objectives.
2. SCOPE
• Works professionally and effectively with all employees, in a high volume, fast-paced environment.
• Communicates professionally and regularly with external clients (patients, clients, and health care providers).
3. RESPONSIBILITIES
• Responsible for claims processing including policy adjudication in a timely and accurate fashion
• Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter
• Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims
• Responsible for performing large dollar claims review according to protocol
• Uses approved tools and references for adjudication in order to determine proper coding of the
claim in relation to diagnoses, procedures, and usual and customary, where applicable.
• Utilizes problem solving skills and negotiating techniques to resolve conflicts.
• Challenges existing processes by thinking out of the box for improvements and shares suggestions with Team Lead/Manager.
• Communicates with Team Lead/Manager as appropriate for problem solving, direction and planning, as well as knowledge issues.
• Remains open to regular performance feedback and applies strategies to successfully achieve objectives
Other
• Adheres to all policies and procedures as outlined in the Employee Handbook and client specific protocols.
• Performs all work in a PIPEDA and HIPAA compliant manner.
• Works in compliance with the Occupational Health and Safety Act and related legislation.
• Ensures strict standards for claimant/client confidentiality and complies with organizational and governmental regulations/policies.
• Other related duties as assigned.
4. YOUR KNOWLEDGE AND EXPERIENCE
• Post secondary education or related experience equivalent.
• Minimum of 2 years experience with billing or coding and/or insurance claim processing
• Knowledge of medical terminology
• Excellent working knowledge of computer programs, including strong Excel skills.
• Exceptional communication skills with the ability to work independently but harmoniously within a team
• Excellent command of the English and German languages.
• Ability to speak multiple languages an asset.
5. EFFORT & WORKING CONDITIONS
• Discretion in dealing with confidential/sensitive information.
• Critical and analytical thinking required.
• Proficient and accurate data entry skills.
• Sits at a desk to perform the duties of the job up to 8 hours daily, as well as walks and stands within the office.
• Works in a fast paced environment with constantly changing priorities.
• Concentrated attention for prolonged periods of time.
• Works in a typical call centre office environment and the noise level is moderately quiet.
• Excessive use of telephone, computer and other office equipment in high volume call centre.
• Sitting for long periods of time.
• Exposure to constant interruptions/distractions, deadlines and multiple demands.
How to Apply
To apply, please contact: Rachel Hoevenaars VP Underwriting & Risk Management My Insurance Recruiter rachel@myinsurancerecruiter.ca JOB Ref #JOS000000227703 total views, 1 today
