About the role

Claims Care Representative responsible for conducting the initial claim review for assigned business lines. Engaging with claimants and stakeholders effectively to ensure claims are processed efficiently.

Responsibilities

Effectively manages case/claims assignments and responds to inquiries from claimants regarding claim status and/or requests for claim forms.
Manages the initial stages of screening claims.
Applies an excellent understanding of certificate and policy provisions.
Sets-up claims, including verifying policyholder information, policy effective date, premium status, and verification of claim eligibility and including ensuring appropriate claim forms are delivered to claimant.
Communicates with key stakeholders including claimant, business partners, plan sponsors, physician, employers, verbally and/or in writing. Handles a variety of inquiries varying in complexity.
Ensures compliance with Quality Assurance requirements and procedures
Maintains compliance all KPI’s, standards, controls, policies, and practices as an active participant in the Company’s Information Privacy and Security Program.
Perform other duties as assigned.

Post-Secondary Education preferred or equivalent work experience.
This role requires strong French and English communication skills because it involves regular, direct interaction with French- and English-speaking customers and colleagues.
Ability to perform tasks simultaneously within deadlines.
Strong attention to detail.
Fundamental knowledge of computers and keyboarding skills.
Strong communication skills (strong telephone and interpersonal skills).
Ability to make decisions with resource guidance
Strong commitment to quality of work
Exceptional customer service.
Knowledge of insurance practices and principles are assets.
Knowledge of medical terminology, policy provisions, and provincial regulations are assets.
FLHC, FLMI or ALHC designation are an asset.

Flexible work arrangements with monthly financial allocations to support your work-life balance;
Generous starting paid vacation time, plus additional vacation days for every year of service;
Paid volunteer day so you can dedicate time to a cause you are passionate about;
Paid personal and wellness days to support your total wellbeing;
Educational assistance of up to $3,500 a year (with approval from your manager);
Flexible health and wellness account (in addition to comprehensive drug and dental coverage) to help pay for a wide range of wellbeing services that are meaningful to you;
Up to 14% of combined contributions to the RRSP matching program;
Family-friendly maternity/parental leave and,
Many more benefits, perks and programs.