Job Description

Nous recrutons actuellement un(e) Adjudicateur(trice) bilingue en assurance accident et sante pour se joindre a notre equipe au Quebec. Il s'agit d'un poste contractuel d'une duree de 18 mois pour un remplacement de conge de maternite, avec possibilite d'emploi permanent a temps plein a la fin du contrat. Le lieu de travail est flexible : nous offrons des modalites de travail en presentiel, en mode hybride ou entierement a distance.



Ce role necessite des interactions frequentes en anglais et necessite la lecture et la preparation frequentes de documents en anglais.



(Job description English)


We are currently recruiting for a Bilingual Accident and Health Adjudicator to join our team in Quebec. This is a contract position covering an 18-month maternity leave with the potential of full-time permanent employment following the contract. The position location is flexible, and we can offer in-office, hybrid or fully remote working arrangements.



This role requires frequent interactions in English and requires reading and preparing documents in English on a frequent basis.

Examiner l'ensemble de la documentation des dossiers lies aux reclamations de faible complexite. Assurer un premier contact avec les nouveaux reclamants dans des delais appropries. Determiner l'admissibilite aux prestations conformement aux polices d'assurance et aux processus de gestion des reclamations. Fournir des rapports verbaux et ecrits detaillant les decisions prises, a l'attention des superviseurs et des examinateurs. Consigner avec precision les informations et notes d'evolution dans le systeme. Rediger la correspondance communiquant les decisions prises. Maintenir une communication continue avec le reclamant pendant le traitement de la demande. Analyser attentivement la police d'assurance applicable afin d'assurer une determination correcte de l'admissibilite a la reclamation. Respecter les delais de traitement exiges par le client. Obtenir les autorisations necessaires, le cas echeant, et proceder rapidement au versement des indemnites ou au remboursement des frais. Soumettre les notes de frais de maniere ponctuelle et precise. Adopter une approche accessible et professionnelle pour favoriser des communications de qualite. S'assurer que toutes les discussions et correspondances par courriel sont bien documentees dans la base de donnees. Fournir une communication appropriee et en temps opportun aux clients concernant les reclamations de faible a moyenne complexite.


Responsibilities (English)

Review all file material on low level claims. Must provide first contact on new claims in a timely manner. Determine entitlement to benefits as per insurance policies and claims handling processes. Provide verbal and written dockets and reports communicating support for decision to supervisors and examiners. Detailed recording in system/progress notes. Prepare correspondence communicating decisions. Maintain communication with claimant while decision pending. Careful analysis of responding policy to ensure correct determination of eligibility of claim. Adhere to Client turnaround timelines. Obtain authority where required and issue indemnity or expense payment in timely manner. Timely and accurate expense account submissions. Approachable style to facilitate qualitative communications. Ensure notes are taken and added to the database confirming the discussion/email details Appropriate and timely communication with customer regarding low to mid-level claims Minimum de deux (2) annees d'experience en adjudication de reclamations en assurance accident et maladie. Bilinguisme en francais et en anglais. Permis en assurance de dommages - lignes de particuliers (AMF). Une formation postsecondaire dans un domaine lie a l'assurance constitue un atout. Experience en reglement de sinistres, y compris l'enquete et la redaction de rapports detailles sur des reclamations multirisques. Excellente capacite a interagir avec les clients, les reclamants et le personnel de terrain pour l'echange d'informations necessitant souvent une analyse approfondie. Excellentes aptitudes interpersonnelles, permettant une communication efficace, tant a l'oral qu'a l'ecrit, avec les employes, les assures, les employeurs et divers professionnels du secteur (assurance, medical, juridique). Capacite et volonte d'apprendre a utiliser plusieurs systemes informatiques. Solides competences en analyse et en prise de decision. Capacite a gerer plusieurs taches simultanement. Aptitude a s'adapter efficacement au changement. Excellentes competences en informatique et en production de rapports. Esprit d'equipe et excellentes aptitudes en service a la clientele.

Qualifications (English)

Minimum 2 years Accident and Health Adjudication experience. Bilingualism in French and English. AMF personal lines license. Post secondary education in an insurance related field is an asset. Experience in adjusting including the investigation and detailed reporting of multi-line claims. Excellent ability to interact with clients, claimants and field staff for the exchange of information often requiring analysis . Excellent interpersonal skills are required to enable effective interaction and communication in both oral and written format with employees, policyholders, employers and other insurance/medical/legal professionals. The ability and willingness to learn multiple computer systems. Strong analytical and decision-making skills. Ability to multitask. Ability to effectively manage change. Strong computer and reporting skills. Must be a team player with outstanding customer service skills. Willingness to work in a dynamic environment with opportunity for career growth.


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Because a claim is more than a number -- it's a person, a child, a friend. It's anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community - one claim at a time.



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