Claims Analyst, Case Management - Cambridge, Canada - Cowan Insurance Group

Cowan Insurance Group

Verified Company

Cambridge, Canada

3 weeks ago

Posted by:

Sophia Lee

beBee Recruiter

Description

What's the ask?

Reporting to the Manager, TPA Claims, the Claims Analyst provides support to the department with respect to claims adjudication specifically focusing on case management.

The claims Analyst is responsible for the timely and accurate review of claims information which includes reviewing complicated claims, maintaining records, conducting follow-ups and approving claims and estimates.

The Claims Analyst must have excellent attention to detail and familiarity and comfort managing and overseeing the processing of medical claims efficiently, accurately, and in a manner that protects the interests of our clients while also providing satisfactory customer service.

The Claims Analyst is also responsible for general technical assistance, project support and performing related tasks to assist with other initiatives supporting the strategic direction of the department.

More specifically, the Claims Analyst will:

Assess complex claims to determine eligibility criteria, requirements, and maximums
Analyze estimates for approval
Review claim files
Obtain additional information needed to assess a claim either through a provider or a subscriber;
Assist in identification and actualization of cost containment opportunities
Ensure regular open lines of communication and conduct regular followups with treatment providers, members, and internal and external stakeholder
Work closely with our Medical Consultant for review and approval of claims
Review and analyze data for completeness and accuracy
Prepare correspondence and confidential documents
Effectively manage a client case load
Ensure the clients needs are met efficiently and accurately
Interact with a variety of stakeholders, providers and other team members
Participate in various special projects including continuous improvement initiatives
Support other business initiatives/projects as assigned

What does it take?

Postsecondary diploma in a related field or equivalent training acquired from a combination of relevant work experience and education
12 years of experience in claims management or equivalent training
Medical knowledge and experience
Strong attention to detail, organizational, time management and prioritization skills
Demonstrate good judgement, reliability, and professionalism in fast paced environment
Strong initiative, planning, and problemsolving skills, including an ability to focus on both details and results
Ability to work under pressure
Comfortable working independently with mínimal supervision
Sound judgement and critical thinking skills
Analytical, judgement and comprehension skills
Excellent written and verbal communication skills
Ability to work in a team as well as independently
Excellent customer service skills and professionalism
Bilingual, written and oral (English and French), is considered an asset

Who we are

Canadian-owned and operated, Cowan Insurance Group is a leading independent insurance brokerage and consulting operation, providing real value to our clients.

With close to 500 employees operating out of 9 locations across Canada, we're proud to have been named one of Canada's Best Managed Companies since 2012.

We partner with leading national and international insurance companies to:

deliver insurance and risk management solutions to businesses, organizations and individuals

- advise on and create retirement, group benefits, disability management and international benefits programs for employee groups.

We also offer wealth and asset management as well as financial and succession planning services to individuals, and specialize in property, casualty and credit insurance.

What sets us apart?

Be in good company
Integrity matters. It drives our award-winning workplace culture and fuels our collective desire to help our clients, employees, and communities thrive.

Challenge your thinking
You're valued for your passion, drive and creativity. The pace is fast, but the work is meaningful, interesting, and complex, just the way you like it.

Grow together
We believe in your potential. If you're looking to develop your expertise with learning opportunities and mentoring, we'll make that happen.

Benefits and perks

Competitive salary
Participate in our comprehensive benefits plan on day one — no waiting period
Companymatched Retirement Savings Plan
Companypaid training and development courses
Community involvement

Are you interested?
Send in your cover letter and resume and share your unique story with us.

While we appreciate the interest of all applicants, we will contact only those selected for interviews.

If you are an applicant with disabilities and require accommodations, please let us know at the time of our contact so that we may arrange for their provision.