Medical Insurance Claims jobs in Toronto, ON

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