Claims Examiner
Teema Solutions Group - Montréal, QC

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My Healthcare client is looking for a Claims Examiner on a full time basis in Montreal, QC. My client would like this resource to start ASAP.

Title: Claims Examiner

Ref: 5752


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
G ood 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