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Medical Claims jobs in Ontario

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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…
    • Expatriate medical insurance; phone/data stipend; statutory benefits; three weeks' vacation.
    • Hands-on Airbnb/VRBO hosting experience with a track record you can…
    • Taking claims reports from clients.
    • Flexible medical, dental, vision and extended health care coverage.
    • Sales and service support are provided from their…
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    •  Maintain GL and ABI claim files and document claim file activities in accordance with established procedures Utilize evaluation documentation tools in…
    • Ensure claims are tracked, monitored, and analyzed, identifying trends and recommending or implementing appropriate corrective or preventative actions.
    • Manage a caseload of complex Accident Benefits matters, ensuring rehabilitation providers, insurers, and other stakeholders remain engaged and accountable…
    • ✅ Opportunity to leverage your medical, legal, or claims experience in a corporate setting.
    • Apply judgement and technical expertise across medical, legal, and…
    • Conducting claim audits, drafting claim audit reports and providing claims insight to various audiences.
    • Coordinate Canadian claims data for monthly claims…
    • Corresponding with clients, insurance adjusters and medical providers to gather information or clarification needed for claims processing.
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    • Manage challenging coverage claims with tact and professionalism.
    • Litigations claims : 3 years (required).
    • Minimum 3 years of experience handling bodily injury…
    • Review and organize medical records, assessments, and other file documentation to support ongoing claims.
    • Draft and prepare correspondence to defence counsel,…
    • 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.
    • Have knowledge of High Intensity Needs and to ensure submission of claims to the Ministry within appropriate time frames.
    • RN license with the CNO (required).
    • Oversee insurance coverage and claims management.
    • Experience in a manufacturing, healthcare, dental, medical technology, laboratory services, or a related…
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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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