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    • Experience with medical coding standards.
    • Experience in the EU/UK health insurance industry is required.
    • The Claims Examiner will be responsible for processing…
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    • Expert knowledge of ICD-10-CA/CCI coding practices and policies.
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    • Submit medical claims accurately and efficiently to insurance payers.
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    • Generous benefits, including extended health, dental, and life insurance; these benefit premiums are 100% paid by PBC.
    • Key Ways This Position Makes An Impact*.
    • Has experience in the medical field, medical transcription, or medical administration (an asset).
    • A complete group insurance plan, from day 1;
    • Collaborate with medical staff to ensure proper coding and documentation of procedures and diagnoses using current medical terminology.
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    • Compensation: $55,000-$65,000.
    • Experience in the insurance or reinsurance industry, with an understanding of underwriting, claims or actuarial data.
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Job Post Details

Claims Examiner
$48,000–$52,000 a year
Full-time

Job details

$48,000–$52,000 a year
Tuition reimbursement, Paid time off, Vision care, Dental care, Employee assistance program, Disability insurance, RRSP match, Extended health care
Full-time
Overtime, Weekends as needed, Evenings as needed, Monday to Friday
Remote in Canada

Full job description

It's fun to work in a company where passion meets profession, and every team member is not just an employee but a dedicated enthusiast, making the work journey truly enjoyable and fulfilling!

About Us:

We are seeking ambitious individuals who share our values and our passion for making a positive impact on people's lives around the world. If you are looking for a career that challenges and inspires you, you've come to the right place.

About You

You are an experienced Claims Examiner skilled at Excel, can handle a large claims load, multi-task, and meet tight deadlines. You thrive in a fast-paced environment providing excellent customer service in both the turnaround of the claim and handling emails and incoming calls. You will have the desire to develop an in-depth understanding of this position and be able to easily maneuver through assessing claims and inquiries. You are a very strong team player.

The Claims Examiner will be responsible for processing a variety of different claims and communicating

these decisions to providers and clients. This role requires strong time management skills,

claims experience, and strong Excel skills.

In this role, you’ll get to experience:

  • Process EU and UK health, dental, and pharmacy claims
  • Adjudicate claims based on approved Letter of Guarantee periods for the client
  • Provide excellent customer service for claims matters both verbal and written

correspondence

  • Handle both inbound and outbound calls to EU/UK health providers as required
  • Ensure all work complies with the PIPEDA and GDPR
  • Reconciliation of claims with Healthcare providers
  • Data Entry is required to key in scanned claims/invoices into the V9 system
  • Maintain concise file documentation consistent with corporate policies
  • Provide overall portfolio management of assigned claims files
  • Provide guidance and mentorship to peers
  • courier/mail management
  • Other related duties as assigned

What you bring:

  • High school diploma or equivalent

Required Skills

  • Experience in the EU/UK health insurance industry is required
  • Minimum 2-3 years of claims processing experience
  • Experience in processing health, dental, and pharmacy claims
  • High level of proficiency in Microsoft Office suites, specifically Excel
  • Superior verbal and written communication skills
  • Strong time management and organizational skills
  • Strong analytical and problem-solving skills

What do you need to succeed?

  • Cost containment/provider relations experience
  • Proficiency in Arabic, German, and French language is a plus.
  • Experience with medical coding standards
  • Dispute resolutions experience

Additional Notes

  • The hours for this position are 9 am-5pm EST from Monday through Friday. Occasional overtime on evenings and weekends is required.

What’s in it for you:

  • Hybrid work environment
  • Excellent health benefits
  • Employee assistance program
  • Wellness account
  • RRSP matching
  • Minimum 3 weeks’ vacation
  • Generous amount of sick and flex days
  • Tuition reimbursement program
  • Opportunities to learn new skills, grow, and move into different roles
  • A work environment that embraces diversity and promotes inclusivity.
  • Supportive leadership prioritizes your success and cares about your well-being.
  • A growth trajectory designed to expand vertically and horizontally, providing opportunities to pursue your passions and acquire new skills.

Job Type: Full-time

Pay: $48,000.00-$52,000.00 per year

Benefits:

  • Company events
  • Dental care
  • Disability insurance
  • Employee assistance program
  • Extended health care
  • Flexible schedule
  • On-site parking
  • Paid time off
  • RRSP match
  • Tuition reimbursement
  • Vision care
  • Wellness program

Work Location: Remote

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