Medical Claims Examiner jobs

Who We Are

With every job, there’s always the question of “why”. Why join a company? Why be part of their mission? Here, the why is easy. It’s because at some point, we’ve all needed someone there for us.

At the OTIP Group of Companies (OGC), we believe that something special happens when employees feel valued for the work they do, supported as the people they are, and included in the very fabric of the organization: they bring their best to work every day. And that's why we mean it when we say we put our people at the centre of everything we do. Join us as we grow our way into a future that reimagines what it means to deliver meaningful benefits support and service.

What You’ll Do:
The Accident Benefits Claims Examiner is responsible for assisting insured members through Statutory Accident Benefits injury rehabilitation programs and the resolution of minor to moderate claims. This includes establishing a prompt relationship with insured members and their legal representatives and assessing quantum while ensuring fiduciary, regulatory and contractual compliance, adhering to organizational service standards, operational targets and core competencies.
Reporting to the Senior Manager, National Injury, the core parts of your role will be to:

• Deliver a superior customer experience which includes responding to all general inquires, initiating and maintaining contact with insured members, and assisting with commodity claims overflow.
• Review and determine eligibility for Statutory accident benefits by gathering information from insured members, health practitioners, employers, police, claimant’s lawyers, accountants, and other insurers or programs with income continuation plans relating to minor to moderate claims.
• Make decisions by considering all information and consulting with legal and medical experts when required.
• Maintain quality service and adheres to organizational standards to deal with all aspects of file handling, including reserving, expense and loss control, questionable claims, and creating defined disposition plans for future handling leading to file closure.
• Assist senior AB team members in Arbitration and License Appeals Tribunal proceedings and prepares documentation for case conferences and hearings on behalf of key stakeholders. Provides support and assembles documentation on benefits being disputed along with resolution recommendations.
• Keep claims information confidential to protect operations and insured members.
• Responsible for data integrity, issuance of payments to vendors, insureds and experts and maintaining well-organized claim files while ensuring accuracy of inputted data.
• Adhere to partner's guidelines, contracts, and insurance regulations to ensure legal and regulatory compliance.
• Actively participate in coaching and training sessions and collaborates with team members and management.
• Take an active role in creating an environment of continuous improvement of work efficiencies and highlighting value work.
• Perform other duties within competence, as assigned.

Let’s Talk About You:
This is the unique blend of skills and experience we would love to see in an ideal candidate:

• A post-secondary education and/or college diploma within related field
• CIP designation or working towards designation.
• An All-lines Adjuster’s license in Ontario and Alberta (Level 2 minimum).
• 3+ years’ experience with a good understanding of both Ontario and Alberta in accident benefits.
• 2 years’ experience in all lines claims adjusting.
• Experience and knowledge in injury claims medical rehabilitation concepts and medical terminology is preferred.
• Excellent communication skills verbal and written to effectively work with internal and external stakeholders.
• Strong time management and organizational skills to manage competing priorities.
• Current Microsoft Office working knowledge
• Ability to learn and adapt in a fast-pace environment including working with various computer programs, databases and software.
• Ability to work independently and as part of collaborative team environment
• The ability to communicate in French is asset.

We also consider your potential. If you know you have what it takes to do the job, but your experience doesn’t exactly match the qualifications above, we encourage you to apply and provide us with more details about why you think you would be a great fit.

Working Conditions:

• General office environment.
• May be required to work overtime.
• Participation in the Catastrophic Response Team.
• Flexible work week 35 hours: Monday through Friday between 8 am – 6pm. Saturday 9am – 1pm.

Salary Range:

This position offers a competitive salary within a range from $57,669 to $79, 295, along with rewarding bonuses that recognize your dedication.

At the OTIP Group of Companies (OGC), we value transparency and take multiple factors into account when determining your starting salary, including your skills, experience, and alignment with the role as well as internal equity, while positioning you for continued growth and recognition over time.

Some of the Perks We Offer:

We offer best-in-class pension and benefits, total reward programs and comprehensive mental wellness support to set you up for every success in and outside of work. Here are just some of the reasons you’ll love working here:

• Defined benefit pension plan for a financially confident retirement

• 100% coverage of approved continuing education and licensing fees

• Access to a wealth of learning resources, including LinkedIn Learning for professional development

• Flexible work-from-home and hybrid options

• Unlock your potential with opportunities for advancement

Let’s work together! If you are interested in this opportunity, please apply online.

The OTIP Group of Companies (“OGC”) is a group of affiliated organizations operating under a shared purpose and values. OGC is comprised of Ontario Teachers Insurance Plan (OTIP), Curo Claims Services, and Orbit Insurance Services.

Candidate communications may refer to OGC when referencing any of the affiliated organizations applied to.

This recruitment process uses artificial intelligence tools to assist with screening and assessing applications. All hiring decisions include human review.

OTIP and its group of companies strive to create an accessible and inclusive work environment where everyone is treated with respect and dignity. Upon individual request, we will endeavor to remove any barrier to the recruitment and selection processes and provide accommodations for persons with disabilities.

As a business, we protect what matters most to our members. As an employer, we value what matters most in our workplace. Together, this includes fostering a diverse, equitable and inclusive environment for all. We are committed to learning and evolving so we can continue to celebrate what makes us special. You are who you are, and our differences are what make us unique.

We are an equal opportunity employer and encourage applications from all qualified individuals. We thank all applicants for their interest; however, only candidates selected for an interview will be contacted.