Claims Assessor - Windsor, Canada - Global Excel Management

Global Excel Management

Verified Company

Windsor, Canada

1 week ago

Posted by:

Sophia Lee

beBee Recruiter

Description

Job Description:

Non-Medical Claims Assessor

As a Non-Medical Claims Assessor, you will evaluate and enforce claim benefits and limitations based on a comprehensive understanding of the applicable policy wording.

The claims assessor is responsible for qualifying a claim/bill for payment and reviewed for customer service and may require direct client contact.

The assessors are responsible to contribute to cost containment efforts by validating bills for services rendered, authenticity and reasonable and customary charges.

What does your typical day look like?

Review applicable policy wording to validate claim coverage;
Review bills for rendered services, coding and reasonable & customary charges ensuring clean bill components are present and are directed to the appropriate internal financial process;
Claims are reviewed with precision for compliance with expressed client directives (as applicable)
Establish presence of claim requirements as per policy wording (i

e:
proof of payment and authenticity of bills/claims)

Research and confirm global claim influences (i.e. travel advisories)
Contact client to request missing claim components as required for adjudication;
Clarify and explain denials if required;
Ensure creation of appropriate follow up workflows;
Confirm and adjust (if required) claim entries.

Skills and Requirements:

College diploma or equivalent;
Knowledge of insurance product benefits and limitations;
Comprehension of healthcare systems and billing practices;
One to two years of experience in a customer servicerelated position;
Strong decisionmaking skills and attention to detail;
Excellent verbal and written communication;
Good organizational skill and ability to prioritize;
Proficiency in the Microsoft suite products;
Clear and effective communication in English or French (written and verbal); other languages such as Spanish are an asset;
Available to work daytime schedule. Evenings and weekends may be requested with

- appropriate notice.

When you apply:

If you require assistance or accommodation during our recruitment process, please notify Human Resources so that we can review and consider how we may be able to assist you based on your individual needs.

Note:
Only applicants selected for an interview will be contacted.

We offer you:

At Global Excel we believe in investing in our employees