Our Client is currently seeking a Bilingual Claims Adjudicator for a client base across Canada. Product Lines include Individual Disability, Critical Illness, Life Waiver of Premium and eventually Long Term Care Policies. Applicants must be willing to work in a team environment
- Establish and maintain exemplary customer service to policyholders, agents, marketing centers/
- Obtain proper file information and review with policy provisions to verify eligibility
- Manage ongoing claims by requesting further medical, financial documentation or investigations as required and consult with specialists in all areas.
- Review claims and underwriting files for proper disclosure of past medical history, exclusions, riders, endorsements; administer policy enhancements, premium waiver and other policy benefits
- Document the claim file to ensure an accurate record of events that transpire in the claim handling
- Manage litigation claims ensuring controls are maintained and cases move forward at an appropriate rate; suggest and review litigation reserves and provide quarterly updates
- Attend Examination for Discoveries, Mediations and attend court trials in Quebec and rest of Canada
- Accurately maintain claim records on System to ensure accuracy of reserve calculations
- Reconcile open claims files to actuarial records on a semi-annual basis
- 2-3 years’ experience in adjudicating disability and critical illness claims (individual claims preferred).
- Bilingual in both French and English
- Customer service oriented individual with negotiating skills is essential.
- Excellent interpersonal skills with good oral and written communication skills in English and French for use in dealing with internal and external customers, claimants, brokers, physicians, employees, hospitals, investigators and lawyers.
- Must have a good working knowledge of medical conditions and terminology, as well as experience in the interpretation and application of financial documentation and fair claims practices.
- Must have working knowledge of government legislation and legal precedents, the Insurance Act and/or Quebec Civil Code.
- Ability to respond constructively and decisively in high pressure or emotional situations and to respond positively to change.
- Good analytical skills to evaluate conflicting information from various key sources in order to assess risk in making timely and effective decisions with appropriate interpretation of policies and procedures.
- Good working knowledge of the underwriting process.
- Ability to handle discoveries/trials re litigation
- Customer service oriented individual with good negotiating skills is essential
- Proven ability to make decisions and handle pressure
- Ability to work in a team environment
Special Conditions: Overtime may be required during peak periods.