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Medical Claim Adjudication jobs in Ontario

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    • Investigate, evaluate and determine eligibility for initial and ongoing payment claims based on medical information, job requirements, non-medical factors,…
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    • Ensure timely and thorough investigation and adjudication of medical claims.
    • Answer queries from customers, legal representatives and medical clinics while…
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    • Ensure timely and thorough investigation and adjudication of medical claims.
    • Answer queries from customers, legal representatives and medical clinics while…
    • Manage leave and disability cases from straightforward to complex, including claim adjudication, workplace accommodations, and gradual return-to-work plans in…
    • Minimum 10 years of claims adjudication experience including deep knowledge of Life, Critical Illness, Disability and Long-Term Care.
    • Incident/claims data analysis for trend identification.
    • Manage all WSIB, CNESST, and non-occupational claims, including timely reporting, documentation, return-…
    • Experience: 5+ years of experience in a claims management role.
    • Experience: Minimum five (5) years of claims-related work experience.
    • Minimum 10 years of claims adjudication experience including deep knowledge of Life, Critical Illness, Disability and Long-Term Care.
    • Prior insurance experience and knowledge in injury claims, medical rehabilitation concepts, and medical terminology is preferred.
    • Collaborate with external partners to maintain a strong and effective claims management ecosystem.
    • 5–7 years of progressive leadership experience, ideally…
    • Experience working in commercial lines claims and retail claims environment would be an asset.
    • In this position, you will be handling any of the following types…
    • Ensure claims are handled in accordance with company claims philosophy, internal protocols, and reserving practices.
    • Property claims experience is an asset.
    • Currently, 30–40% of denied medical claims go uncontested because practices lack the staff and capital to contest them.
    • Familiarity with claims systems, insurer assessments, and medical provider protocols.
    • Independently manage MIG claims, including those with specified benefits…
    • Minimum of 2 years of experience as a claims adjuster.
    • Participate hands-on in the resolution of simple to moderate claims and coverage issues.
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Job Post Details

Bilingual Claim Manager - job post

THE EMPIRE LIFE INS. CO
3.3 out of 5 stars
36 York Mills Rd Ste 200, North York, ON M2P 2E9
$55,968–$98,580 a year - Full-time

Job details

Pay

  • $55,968–$98,580 a year

Job type

  • Full-time

Location

36 York Mills Rd Ste 200, North York, ON M2P 2E9

Benefits

Pulled from the full job description

  • Dental care
  • Life insurance

Full job description

Bilingual Claim Manager

Location: Remote, or if local to an office, hybrid - Kingston, Toronto, or Montreal

The total target compensation (TTC) range, including salary and target bonus, is $55,968 - $98,580. This TTC range is applicable to permanent roles only; fixed-term contract and casual roles are not eligible for annual bonus and would receive only the base salary component. The actual base salary offered within this range will be determined by the successful candidate’s skills and experience, as well as internal equity.

Empire life is looking to hire a Bilingual Claim Manager to join our Group Operation team! This posting is an opportunity to express your interest for anticipated openings. The Claim Manager applies disability management best practices to effectively manage the payment, expenses and risk associated with weekly indemnity and long-term disability claims within approved authority limits. The incumbent is guided by defined procedural constraints, and works under the moderate supervision of the Manager, Life and Disability Claim Management.


Why pursue this opportunity


Impactful work - get the opportunity to work on meaningful projects that have a positive impact on our customers, our company, and society as a whole.
Deliver excellence - provide a personal, accurate, professional, and courteous service and resolution to our customers.
Diversity, equity, and inclusion - we are committed to creating a diverse, equitable, and inclusive workplace and welcome candidates who share this commitment.

What you’ll be working on
  • Investigate, evaluate and determine eligibility for initial and ongoing payment claims based on medical information, job requirements, non-medical factors, contract terms and department/industry protocols within established service standards
  • Manage active claims duration by utilizing best practices
  • Interview claimants and employers through telephone interviews
  • Based on department standards, ensure proactive and timely communication with our customers regarding claim status and developments
  • Formulate and implement a detailed case management plan on each file with a focus on a timely, sustainable and safe return to work; interact with and appropriately challenge treating physicians and employers; make referrals for independent medical assessments and third party organizations
  • Collaborate with in-house return to work facilitators to design and monitor return to work programs
  • Collaborate with team members to exchange ideas, gather information and offer solutions on claims
  • Accountable for positive file resolution and appropriate outcomes

What we’re looking for you to have

  • Bilingualism in French and English is required
  • 2+ years work experience in disability claim management
  • Knowledge of medical terminology and Disability Management best practices/protocols
  • Knowledge of relevant provincial employment legislation and legal requirements
  • Strong experience with word processing, spreadsheets, email, internet and database software
  • Completion of a post-secondary courses in kinesiology, anatomy, biology, life sciences or rehabilitation
  • Well-developed verbal/written communication and interpersonal skills
  • Well-developed customer relations skills
  • Ability to work independently and as a collaborative team member
  • Ability to prioritize and balance multiple tasks
  • Ability to analyze, evaluate, negotiate, make decisions and resolve problems
  • Ability to apply policy terms and adjudication guidelines
  • LOMA 280, 290, HIAA, CEBS - GBA are assets
  • If you are applying for a position which is open to applicants across Canada, unless otherwise indicated in the position, language proficiency in English is required for communicating with customers, advisors, or employees across Canada.

Our hiring process includes AI screening for keywords and minimum qualifications. Recruiters review all results.

Beyond the salary

For regular full-time positions, Empire Life offers a comprehensive total rewards package that includes:
  • Competitive salaries with annual pay increases
  • Annual bonus program, which recognizes both strong company performance and individual contributions, for non sales positions
  • Competitive uncapped commission, for sales positions
  • A comprehensive employer-funded benefits package that includes life insurance, disability, health and dental and a generous health account
  • Flexible work arrangements and an annual allotment of personal health days.
  • Four weeks annual vacation from hire date
  • A defined contribution pension plan with generous employer matching
  • Top up programs for parental leave and compassionate leave
  • Employer-sponsored wellness and recognition programs

  • A cash employee referral program

To learn more about working at Empire Life, visit https://www.empire.ca/workatempire.

Get to know us

Empire life is proud to be an equal opportunity employer. We celebrate diversity, are committed to creating an inclusive environment, and welcome everyone to participate in our application process. We encourage those of all backgrounds and experiences to apply, even if you don't believe you meet each unique qualification outlined. Applicants will receive equal consideration without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, disability, or age.

Empire Life welcomes applications from people with disabilities and disabled people. Accommodations are available upon request for candidates taking part in all aspects of the screening and selection process. If you need this job posting in an alternative format or have any accessibility questions, please contact recruitment@empire.ca

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