Claims Examiner

Claims Examiner ( Contract) $50,000 to $52,000Hybrid 1 day in office or Fully remote for out of city candidates ( Must be in Canada)Vacation and benefitsLarge Travel Insurance companyResponsibilities· Process health, dental, and vision claims up to the designated limit· Adjudicate claims according to various benefit policies· Provide excellent customer service for claims matters both in person and via written correspondence· Handle both inbound and outbound calls to members and health providers as required· Work closely with both the Assistance and Finance departments, as well as other departments on a day-to-day basis· Ensure all work complies with the PIPEDA and HIPAA· Support department initiatives that increase revenues, save costs, and meet company objectives· Maintain concise file documentation consistent with corporate policies· Adjust reserves to ensure that reserve activities are consistent with corporate policies· Provide overall portfolio management of assigned claims files· Develop action plans and report claim progression on a regular basis· Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures· Present cases and participate in discussions during department meetings· Provide guidance and mentorship to peers· Participate in client implementations and projects where required· Other related duties as assignedQualifications and Education Requirements· High school diploma or equivalent· Experience in the travel insurance industry is required· Minimum 2-3 years of relevant Canadian claims processing experience· Experience in processing health, dental, and vision claims· High level of proficiency in Microsoft Office suites, specifically Excel· Superior verbal and written communication skills· Strong time management and organizational skills· Strong analytical and problem-solving skillsPreferred Skills· Snowbird, expatriate insurance, TPA experience· Cost containment/provider relations experience· Experience with medical coding standards· Dispute resolutions experience· GHIP recovery/coordination of benefits/subrogation· Experience in handling US medical invoices/claims