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Medical Claim jobs in Toronto, ON

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    • Evaluate claim documentation, repair estimates, and policy coverage details to determine claim validity.
    • Collaborate with internal teams to resolve complex or…
    • Obtaining productions and medical records.
    • Preparing Case Conference summary forms.
    • Daily communication with clients and third parties.
    • Corresponding with clients, insurance adjusters and medical providers to gather information or clarification needed for claims processing.
    • Provide support to the claims department and handling claim referrals.
    • Review, assess, analyze, and evaluate detailed medical and non-medical risks, determine…
    • Prepare medical chronologies and briefs to assist lawyers in understanding the medical issues.
    • 5+ years supporting medical malpractice.
    • Maintain a cloud database of medical information.
    • Summarizing medicals: 1 year (required).
    • Refer, organize, and manage clients' medical assessments.
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    • Experience/exposure to financial management methods, the nature of insurance risk and reinsurance costs, underwriting, claims underwriting and reinsurance.
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    • Flexible medical, dental, vision, and extended health care coverage.
    • Business Partnership: Work with product, underwriting, sales, and claims to translate…
    • Send electronic claims to the insurance providers and take payments from the customer.
    • Transfer and document the medical and other information of a patient to…
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    • Seeking an experienced AbInitio Specialist with 5 to 7 years of expertise to design develop and optimize data integration solutions.
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    • Design develop and maintain data pipelines using PySpark for largescale data processing.
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    • Strong knowledge of Canadian healthcare regulations, including Health Canada guidelines and medical device compliance.
    • Familiarity with electronic medical records systems is essential.
    • Previous experience in an administrative role within a medical or dental office is preferred.
    • Provide technical support where required to assist providers with electronic claims submissions.
    • The Provider Call Centre is the main venue for communication…
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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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