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Medical Insurance Claim jobs in Toronto, ON

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    • Review and analyze insurance claims related to GAP and Mechanical Breakdown Insurance policies.
    • Evaluate claim documentation, repair estimates, and policy…
    • Maintain a cloud database of medical information.
    • Summarizing medicals: 1 year (required).
    • Refer, organize, and manage clients' medical assessments.
    • Information Gathering & Consultations: Gather appropriate information from clients during detailed intake screenings for prospective Motor Vehicle Accident (…
    • Manage direct billing to insurance providers, ensuring accurate and timely submission of claims and payments.
    • Do you have experience communicating directly with…
    • A valid Ontario Driver’s License (Class G) and access to a reliable vehicle and insurance is an asset.
    • Supports programming, oversight of medical care, skill…
    • Verify extended health insurance coverage and process direct billing claims.
    • Communicate with insurance adjusters, legal representatives, healthcare providers,…
    • Assist with billing and insurance claims processing.
    • Verify insurance coverage and collect necessary patient information.
    • Manage challenging coverage claims with tact and professionalism.
    • Obtain approval from Manager on claims above authority.
    • CIP or working towards designation.
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    • Process patient information, insurance details, and claims according to office policies.
    • Minimum 1 year of dental or medical administration experience (*dental…
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    • Process patient information, insurance details, and claims according to office policies.
    • Minimum 1 year of dental or medical administration experience (dental…
    • Prepare correspondence, requesting medicals, employment records.
    • Review and summarize medical documents and other file contents.
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    • Experience/exposure to financial management methods, the nature of insurance risk and reinsurance costs, underwriting, claims underwriting and reinsurance.
    • GL claims : 5 years (required).
    • Oversee claims operations to ensure efficient, high-quality service.
    • Please explain your experience with bodily injury insurance…
    • Administer U.S. medical, dental, vision, life insurance, disability, HSA/FSA, and voluntary benefit programs.
    • Strong Excel, reporting, HRIS, vendor-management,…
    • Coach and develop disability claim specialists and consultants.
    • Manage action plan and decision (or provide recommendation) on highly complex disability claims.
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Nationally Licensed Insurance Claims Adjudicator - GAP Insurance Mechanical Breakdown Insurance
Guarantee VC
·
4.0
220 Duncan Mill Road, North York, ON M3B 3J5
$60,000–$65,000 a year
Permanent, Full-time
Apply now

Job details

Here’s how the job details align with your profile.

Pay

$60,000–$65,000 a year

Job type

Permanent
Full-time

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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