- travel insurance claims
- medical insurance claims
- Snowbird insurance
- Expatriate Insurance, TPA, Medical invoices, GHIP
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Claims Examiner - Winnipeg, Canada - TEKsystems
Description
Description:
As a Claims Examiner your main responsibility will be make decision on medical claims for government workers who are stationed outside of Canada. Claims have already been entered through an automatic process or through the claims admin team and you must asses the claim and verify accuracy, authenticity, verify allocation of benefits, then make a decision (adjudicate) based on limits from the specific provider. This is a highly independent role, with some authority limits, but candidates must be comfortable making decisions on their own. Volume = 50-70 invoices daily which translates to 20 claims a day. You may take on some communication pieces if it relates to claim. Claims system they use is called filemellon.
Types of clients:
1) Clients travelling outside of Canada, but are Canadian residents.
2) Federal employees but are deployed outside of Country.
Skills:
Additional Skills & Qualifications:
Responsibilities
• Process travel insurance claims for medical, trip cancellation/interruption, baggage, dental and vision claims up to the designated limit
• Adjudicate claims according to various benefit policies
• Handle both inbound and outbound calls, complaints, provide excellent customer service for claims matters both in person and via written correspondence
• Work closely with claimants, providers, agents, brokers, other insurance carriers or their representatives
• Work closely with other departments within the company on a day-to-day basis
• Maintain accurate documentation on all claim files
• Adjust reserves in accordance with the insurer's guidelines
• Present cases and participate in discussions during file reviews and appeals
• Ensure all work complies with the PIPEDA and HIPAA
• Support department initiatives and objectives
• Provide guidance and mentorship to peers
• Other related duties as assigned
Qualifications and Education Requirements
• High school diploma or University Degree or equivalent
• Minimum 2-3 years of relevant travel insurance or medical insurance claims processing experience
• Strong analytical and problem-solving skills
• High level of proficiency in Microsoft Office suites
• Superior verbal and written communication skills in English and/or French
• Strong time management and organizational
Preferred Skills
• Snowbird, expatriate insurance, TPA experience
• Experience in handling Canadian and US medical invoices/claims
• Dispute resolutions experience
• GHIP recovery/coordination of benefits/subrogation
• Very strong Team Player
Experience Level:
Intermediate Level
À propos de TEKsystems:
Nous sommes partenaires dans la transformation. Nous aidons les clients à activer des idées et des solutions afin de profiter d'un nouveau monde d'opportunités. Nous sommes une équipe solide de personnes, nous travaillons avec plus de 6 000 clients, dont 80 % faisant partie du Fortune 500, partout en Amérique du Nord, en Europe et en Asie. En tant que chefs de file de l'industrie des services technologiques complets, des services aux talents et des applications du monde réel, nous travaillons avec des leaders progressistes pour favoriser le changement. C'est le pouvoir d'un vrai partenariat. TEKsystems est une société du groupe Allegis.
About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
