Claims Examiner

Join a team where your passion meets purpose! We're not just colleagues – we're enthusiasts who genuinely love what we do and make work enjoyable for everyone.About You: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.What You'll Do: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 policiesAdjust reserves to ensure that reserve activities are consistent with corporate policiesProvide overall portfolio management of assigned claims filesDevelop action plans and report claim progression on a regular basisVerify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and proceduresPresent cases and participate in discussions during department meetingsProvide guidance and mentorship to peersParticipate in client implementations and projects where required Other related duties as assigned What You'll Bring:High school diploma or equivalentExperience 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 skills Preferred SkillsSnowbird, 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 If you don’t meet every qualification listed, we encourage you to apply. At MSH Americas, we value diverse backgrounds, perspectives, and experiences. We are proud to be an equal opportunity employer committed to fostering an inclusive and supportive environment. If you require reasonable accommodations at any stage of the application process, our Human Resources team is here to support you.