Claims Examiner

Claims Examiner

One of TEKsystems top insurance clients is looking to add top talent to their Claims Examiner team. TEKsystems is actively interviewing for this role and encourage those ready to make their next career move to apply. Through our application process, we want to ensure that candidates know their application status and qualified candidates can expect to hear back within 48 business hours after application! We are looking for enthusiastic, knowledgeable claims insurance professionals that have great problem solving skills, customer centric mindset and want to continue to develop their career in the insurance industry (working at an international scale). This opportunity is 100% work from home!

This role begins as a 6-month contract that can enhance someone's professional career through networking and continue to gain valuable insurance sector experience! This client is rapidly growing in size and the potential for permanent full time opportunities is of high possibility given great performance. If you are passionate about delivering exceptional efficient service and providing solutions for client’s needs, you can build a long term career as a highly knowledgeable professional Claims Examiner with our client.

Description:

As a Claims Examiner your main responsibility will be to make decisions on claims for the companies international clients. Claims will have already been entered through an automatic process or through the claims admin team and you must asses the claim and verify accuracy, authenticity, verify allocation of benefits, then make a adjudicate based on limits from the specific provider. This is a highly independent role, with some authority limits, but you must be comfortable making decisions on your own. The volume of claims is typically 20 claims a day where you are handling 50 -70 invoices. You may take on some communication pieces with clients if it relates to claim.

Types of clients:

1) Clients travelling outside of Canada, but are Canadian residents.

2) Federal employees but are deployed outside of Country.

Responsibilities:

• Process travel insurance claims for medical, trip cancellation/interruption, baggage, dental and vision claims up to the designated limit
• Adjudicate claims according to various benefit policies
• Handle both inbound and outbound calls, complaints, provide excellent customer service for claims matters both in person and via written correspondence
• Work closely with claimants, providers, agents, brokers, other insurance carriers or their representatives
• Work closely with other departments within the company on a day-to-day basis
• Maintain accurate documentation on all claim files
• Adjust reserves in accordance with the insurer’s guidelines
• Present cases and participate in discussions during file reviews and appeals
• Ensure all work complies with the PIPEDA and HIPAA
• Support department initiatives and objectives
• Provide guidance and mentorship to peers
• Other related duties as assigned

Required Qualifications:

• High school diploma minimum. Post-secondary considered an asset
• Minimum 2-3 years of relevant travel insurance or medical insurance claims processing experience
• Bilingual: English/French is considered an asset. Superior verbal and written communication skills in English and French
• Strong analytical and problem-solving skills
• High level of proficiency in Microsoft Office suites
• Strong time management and organizational

Preferred skills and considered highly favorable:

• Snowbird, expatriate insurance, TPA experience
• Experience in handling Canadian and US medical invoices/claims (a large portion of claims are from US clients).
• Dispute resolutions experience
• GHIP recovery/coordination of benefits/subrogation
• Very strong Team Player

Scheduling:

Monday - Friday for 8 hour day. Flexible scheduling for work like balance and flexible start times (8 a.m. - 10 a.m.). Additionally, required flexibility in working hours to be able to meet the clients needs (time zone differences).

This position also offers health benefits; This role can move into an extension of contract or move into a permanent role with great performance that could potentially offer future growth opportunities. .

If you meet the qualifications and are ready for your next career move, please apply with your most up to date resume!

À propos de TEKsystems:

Nous sommes partenaires dans la transformation. Nous aidons les clients à activer des idées et des solutions afin de profiter d’un nouveau monde d’opportunités. Nous sommes une équipe solide de 80 000 personnes, nous travaillons avec plus de 6 000 clients, dont 80 % faisant partie du Fortune 500, partout en Amérique du Nord, en Europe et en Asie. En tant que chefs de file de l’industrie des services technologiques complets, des services aux talents et des applications du monde réel, nous travaillons avec des leaders progressistes pour favoriser le changement. C’est le pouvoir d’un vrai partenariat. TEKsystems est une société du groupe Allegis.

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.