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Medical Claim Adjudication jobs in Ontario

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    • Evaluate claim documentation, repair estimates, and policy coverage details to determine claim validity.
    • Stay updated on industry regulations, policy changes,…
    • Maintain accurate records and claim documentation.
    • Review medical records and related documentation where applicable.
    • Pay Rate: $60.00/hour.
    • GL claims : 5 years (required).
    • Oversee claims operations to ensure efficient, high-quality service.
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    • Adjudicates the most complex claims such as higher profile claims, higher dollar value claims or claims with increased litigation risk.
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    • Salary Search: Senior Claims Specialist salaries in Toronto, ON
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    • Review, examine, calculate, investigate, and settle legal expense insurance claims and wrap up liability claims.
    • Assist with the mentorship of junior staff.
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    • The Provider Call Centre is the main venue for communication between providers, clients and members and First Canadian Health regarding day-to-day claims…
    • Incident/claims data analysis for trend identification.
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    • 2 -10 years’ experience handling bodily injury claims, including both general liability/premises operations claims and auto tort liability.
    • Analyze medical, functional, employment and contractual information in order to make timely and accurate decisions on Long Term Disability (LTD) claims.
    • Complete claim consults with designated individuals on all complex claims prior to the adjudication decision on the claim.
    • All-Star Candidates will have:
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    • Manage cases until return to work or claim resolution.
    • All-star candidates will have:
    • You will conduct a detailed functional assessment, review medical and workplace documentation, adjudicate claims in accordance with organizational and client…
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Job Post Details

Nationally Licensed Insurance Claims Adjudicator - GAP Insurance Mechanical Breakdown Insurance - job post

Guarantee VC
4.0 out of 5 stars
220 Duncan Mill Road, North York, ON M3B 3J5
$60,000–$65,000 a year - Permanent, Full-time

Job details

Pay

  • $60,000–$65,000 a year

Job type

  • Permanent
  • Full-time

Location

220 Duncan Mill Road, North York, ON M3B 3J5

Benefits

Pulled from the full job description

  • Paid time off
  • Dental care
  • Life insurance
  • Casual dress
  • On-site parking

Full job description

Job Summary

We are seeking a highly skilled and licensed Insurance Claims Adjudicator specializing in GAP Insurance and Mechanical Breakdown Insurance. In this role, you will evaluate, process, and resolve insurance claims related to mechanical breakdowns and GAP coverage, ensuring accurate adjudication while providing exceptional customer service. The ideal candidate will possess strong analysis skills, negotiation abilities, and organizational expertise to manage complex claims efficiently and effectively. This position offers an opportunity to contribute to a dynamic team dedicated to delivering reliable insurance solutions.

Responsibilities

  • Review and analyze insurance claims related to GAP and Mechanical Breakdown Insurance policies.
  • Evaluate claim documentation, repair estimates, and policy coverage details to determine claim validity.
  • Negotiate settlements with policyholders, repair shops, and other stakeholders to reach fair resolutions.
  • Ensure compliance with company policies, industry regulations, and licensing requirements throughout the adjudication process.
  • Maintain detailed records of claim activities, decisions, and correspondence for audit purposes.
  • Collaborate with internal teams to resolve complex or disputed claims promptly.
  • Provide exceptional customer service by communicating clearly and professionally with claimants and stakeholders.
  • Stay updated on industry regulations, policy changes, and best practices relevant to insurance claim adjudication.

Requirements

  • Valid and current insurance licensing as a Claims Adjudicator or similar credential recognized nationally.
  • Proven experience in insurance claims processing, particularly in GAP Insurance or Mechanical Breakdown Insurance.
  • Strong negotiation skills to facilitate fair settlements while managing stakeholder expectations.
  • Excellent customer service skills with the ability to handle sensitive situations professionally.
  • Analytical skills necessary for detailed review of claims documentation and policy coverage.
  • Organizational skills to manage multiple claims efficiently while maintaining accuracy.
  • Ability to work independently and collaboratively within a team environment.
  • Attention to detail and high level of integrity in handling confidential information.

Pay: $60,000.00-$65,000.00 per year

Benefits:

  • Casual dress
  • Dental care
  • Life insurance
  • On-site parking
  • Paid time off

Work Location: In person

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