Title: Claims Examiner - 5 positions - South shore
Reporting to the Team Lead, Claim Management and Specialists, Examiners with extensive experience, excellent productivity and quality stats will be handling more complex claims. Examiners may specialize in one particular claim type such as Drug, Dental or Extended Health.
What you will be doing:
1. Evaluate and process pended and complex claims within service, quality and productivity levels using defined policies, procedures, plan parameters.
2. Obtain any additional information required to assess and pay claims.
3. Identify and recommend changes to enhance the effectiveness of the claims payment processes.
4. Examiners are required to liase with Medical and Dental Consultants, internal team members, and other departments as required.
5. Identify and report potential cases of fraud and abuse to the Audit Department.
6. Ensure compliance with privacy requirements and internal policies.
7. Manage document retention in accordance with established guidelines.
8. Stay current on all system and process changes. Participate in training as required.
9. Provide Customer support as required.
10. Other duties as assigned by Management.
What you need to have:
- College Diploma in Health Sciences or Administration
- Experience processing Claims in a Canadian Group Insurance Claims Department is required
- Knowledge of insurance legislation and of various government programs
- Strong problem and issue resolution skills
- Performs well under pressure and demonstrates effective time management skills
- Good written and oral communication skills
- Flexibility with assignment and hours. Overtime may be required
- Knowledge of Microsoft Office, Browsers and Business Applications
- Bilingualism (French / English) is required.
It would be nice if you also have:
- Health industry experience
For information about TEEMA Solutions Group and to consider other career opportunities, please visit our website at www.teemagroup.com.