Job Description

Job Description

Our client, a top financial services and insurance client in Canada is looking to hire a Claims Adjudicator role for their team with an initial 6-month contract which is renewable. This role is completely work from home.

The Claims Adjudicator is responsible for managing claims to ensure they meet or exceed client expectations by adhering to high service standards. This role involves making decisions that could impact a member's entitlement to benefits or the amount of benefits payable. The Adjudicator reviews claims for accuracy, processes and evaluates them, and generates the final statement or payment responsibility after applying the member's insurance benefits to the claim. Key Responsibilities:

• Conduct intake calls with claimants, gathering initial information and updating claims tasks in the system.
• Review insurance claim forms and documents for completeness and accuracy.
• Provide general customer support, including guidance on next steps or referrals.
• Assess initial coverage eligibility and communicate appropriately with claimants.
• Summarize employment and mortgage lender documentation.
• Draft written correspondence including requests for additional information and decision communications.
• Support the adjudication team through reporting and various administrative tasks.
• Maintain service standards in accordance with the terms of the Certificate of Insurance.

Candidate Requirements/Must-Have Skills:

• Fully bilingual in French and English (written and verbal)
• Exceptional communication skills for diverse internal and external stakeholders
• Proficient in Microsoft Office 365
• Strong attention to detail and the ability to quickly assess and accurately input information
• Comfortable handling sensitive and confidential information

Nice-to-Have Skills:

• Previous experience adjudicating Life and/or Disability claims
• Familiarity with medical conditions and terminology
• Background in call center or data processing environments

If you are interested & qualified for this opportunity, please send your updated resume in MS Word format to [email protected]

Job Tags

Similar Jobs