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    Health Claims Specialist - Toronto, Canada - Empire Life

    Empire Life
    Empire Life Toronto, Canada

    1 week ago

    Empire Life background
    Regular Full time
    Description

    Health Claims Specialist

    Location: Hybrid- Ontario

    Empire life is looking to hire a Health Claims Specialist to join our group solutions team

    Why pursue this opportunity

  • Our mission - make insurance, investments and benefits simple, fast and easy for our customers.
  • Join a transforming business - we are a medium-sized Canadian company in a stable industry which is rapidly transforming.
  • The environment - we understand the importance of work-life balance and strive to provide a supportive work environment that allows our employees to achieve both personal and professional goals.
  • Play an integral role - this is an opportunity that allows for you to grow your skills, while directly contributing to the business unit you are a part of.

    • What you'll be working on

  • Effectively manages team workflow, productivity, resource constraints/opportunities to meet service delivery objectives
  • Provide prompt and accurate response to enquiries within established service standards; acts as 2nd level escalation/review for health and dental claim appeals; identify and action trends
  • Acts as a primary point of contact for Health Claims, Customer Service Team, or other teams as required, by responding to escalated enquiries; maintains ownership of each inquiry from start to resolution; escalate issues for resolution, identifies and actions process improvements as a result
  • Research, investigate, and collaborate with the appropriate subject matter expert making recommendations or provide a solution; access and obtain data from multiple information systems to respond to inquiries
  • Manages quality program, recommends and implements changes to procedures and training as a result, involve Manager where appropriate
  • Delivers business specific training (initial and ongoing) to employees
  • Develop & maintain content management, training and operational materials
  • Work with Group operations leaders to understand any operational changes and provide recommendations on process improvement
  • Manage various account reconciliations and accounting functions, collaborating with Group Finance leaders where necessary
  • Provide product and process knowledge and technical advice
  • Provide assistance and expertise for business requirements and test scenarios for projects, product launches, and system maintenance releases; validate changes
  • Adhere to complaint handling and privacy procedures

    • What we're looking for you to have

  • 5+ years demonstrated experience in insurance industry
  • Strong technical knowledge of medical and dental terminology
  • Pharmaceutical knowledge
  • Knowledge of word processing, spreadsheet, and database computer software
  • In-depth knowledge of Empire Life systems is an asset
  • In-depth knowledge of the financial service products, policy provisions, and administrative procedures
  • In-depth knowledge of distribution channels
  • Bilingualism (English/French) is an asset
  • Completion of a university degree or college program with successful attainment of a medical professional designation
  • GBA designation or working towards
  • Excellent organizational skills and the ability to prioritize and balance multiple tasks
  • Strong writing, listening and verbal communication skills
  • Attention to detail/accuracy in a high transactional environment
  • Well-developed analytical and problem resolution skills
  • If you are applying for a position which is open to applicants across Canada, unless otherwise indicated in the position, language proficiency in English is required for communicating with customers, advisors, or employees across Canada.

    • Beyond the salary

    For regular full-time positions, Empire Life offers a comprehensive total rewards package that includes:

  • Competitive salaries with annual pay increases
  • Annual bonus program, which recognizes both strong company performance and individual contributions, for non sales positions
  • Competitive uncapped commission, for sales positions
  • A comprehensive employer-funded benefits package that includes life insurance, disability, health and dental and a generous health account
  • Flexible work arrangements and an annual allotment of personal health days.
  • Four weeks annual vacation from hire date
  • A defined contribution pension plan with generous employer matching
  • Top up programs for parental leave and compassionate leave
  • Employer-sponsored wellness and recognition programs
  • A cash employee referral program
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