Claims Examiner - Toronto, Canada - MSH International (Canada) Ltd.

MSH International (Canada) Ltd.
MSH International (Canada) Ltd.
Verified Company
Toronto, Canada

2 weeks ago

Sophia Lee

Posted by:

Sophia Lee

beBee Recruiter
Description

Job Overview


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.


Responsibilities

  • 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 daytoday 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 assigned

Qualifications and Education Requirements

  • High school diploma or equivalent
  • Experience in the travel insurance industry is required
  • Minimum 23 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 problemsolving skills

Preferred 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

Additional Notes

  • The hours for this position are 9am5pm from Monday through Friday. Occasional overtime on evenings and weekends is required.

Job Types:
Full-time, Permanent


Benefits:


  • Company events
  • Company pension
  • Dental care
  • Disability insurance
  • Employee assistance program
  • Extended health care
  • Flexible schedule
  • Life insurance
  • Paid time off
  • RRSP match
  • Tuition reimbursement
  • Vision care
  • Wellness program
  • Work from home

Schedule:

  • 8 hour shift
  • Monday to Friday
  • Overtime
  • Weekend availability

Supplemental pay types:

  • Overtime
pay


Application question(s):

  • Are you willing to undergo a background check, in accordance with local law/regulations?
  • Are you legally authorized to work in Canada?

Work Location:
Hybrid remote in Toronto, ON
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