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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.

Requirements

  • 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.

Benefits

  • 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.

Job title

Job type

Full Time

Experience level

Mid levelSenior

Salary

CA$45,000 - CA$55,000 per year

Degree requirement

Postgraduate Degree

Location requirements

HybridTorontoCanada

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