Reporting to the Manager, the Claims Examiner is responsible for handling, evaluating and assessing medical and dental claims for our insureds in an accurate and efficient manner. You will be expected to be an active team member by supporting work efforts, providing feedback while ensuring customer service excellence. This is a full-time, salaried role with eligibility to a robust benefit plan. guard.me International Insurance recognizes people as our most valuable asset. We look for individuals who like working with and helping people and who are interested in long-term career growth within an established, successful company. The work environment is fast-paced and high-energy. You\'ll get a chance to communicate with others, as everyone\'s input is valued. The culture is truly collaborative. You\'ll be working with an established award-winning team with an impressive track record. If we still have your attention, please read through the responsibilities and qualifications and if you think you\xe2\x80\x99re a good fit, we\xe2\x80\x99d love to review your resume! Responsibilities: \xc2\xb7 Required to thoroughly review claim submission documentation and data entry \xc2\xb7 Detailed analysis required to determine if additional information or documentation is required and delegate tasks accordingly \xc2\xb7 Determine eligibility in an accurate and prompt manner based on policy guidelines and in line with guard.me authority limits \xc2\xb7 Provide reserve recommendations and adjust reserves accordingly \xc2\xb7 Refer cases outside of authority level, preparing referral documentation and materials as appropriate \xc2\xb7 Communicating assessment determination to claimants, when applicable \xc2\xb7 Utilizing critical thinking and solid judgment to solve problems, make decisions and resolve complex issues inherent in handling losses \xc2\xb7 Present and resolve claim disputes to ensure claims were assessed fairly and in accordance with policy guidelines and ensuring high standards are always met \xc2\xb7 Investigating potentially fraudulent claims and taking appropriate action \xc2\xb7 Maintain proper electronic files for claims by collecting, reviewing and organizing all relevant documents and set up new claims using the company software system \xc2\xb7 Answer phone calls and respond to emails; regarding policy coverage or claims and provide or request information as needed \xc2\xb7 Prepare correspondence (faxes, letters, email, etc.) to insureds, providers, and third parties as needed \xc2\xb7 Keep up to date with insurance product knowledge as well as appraisal and investigation techniques and services \xc2\xb7 Liaise with other departments to solve queries as necessary \xc2\xb7 Any other duties as required to assist Claims Team in times of high claims volume and peak periods Education & Experience \xc2\xb7 Minimum of 5 years\xe2\x80\x99 experience in Claims Examination, ideally medical and dental claims \xc2\xb7 Completion of Secondary School Diploma, or equivalent combination of education and experience preferred in an Insurance, Medical or Clinical setting Qualifications and Skills \xc2\xb7 A strong attention to detail with the ability to multi-task \xc2\xb7 Ability to maintain high-level of confidentiality of clients\xe2\x80\x99 information \xc2\xb7 Demonstrate decision making ability \xc2\xb7 Proficiency with mathematics \xc2\xb7 Excellent customer service attitude with an ability to demonstrate this while taking calls \xc2\xb7 Excellent verbal & telephone skills with the ability to maintain a calm and professional demeanor \xc2\xb7 Excellent written communication skills with the ability to compose professional correspondence in English \xc2\xb7 Solid teaming skills to work collaboratively in a positive, energetic and outgoing manner \xc2\xb7 Comfortable adapting to new situations with the ability to perform well, negotiate and problem solve in dynamic situations \xc2\xb7 Experience using Microsoft Office (Word/Excel/Outlook), Adobe Reader, Internet Search Engines (Google Chrome, Mozilla, IE), Tech-savvy with the ability to learn new computer systems and work with industry related software programs \xc2\xb7 Case Management, Medical, Nursing and/or Pharmaceutical knowledge an asset \xc2\xb7 Ability to communicate in a second language is an asset How to Apply: Please submit your cover letter and resume with details of relevant work experience and why you feel you are a good candidate for this position. We thank all candidates, but only those selected for an interview will be contacted. We are not accepting calls from Recruiters at this time. guard.me is an equal opportunity employer and encourages applications from all qualified individuals. Accommodation will be provided to requesting candidates during the recruitment process. Disclaimer: Please note that this document is intended to provide an overview of job accountabilities and does not necessarily list all tasks related to the job. About Us guard.me International Insurance is the premier provider of quality healthcare insurance to the International Education and Travel Market. We provide comprehensive health insurance products for international students who are studying in Canada and for international students who are studying outside of Canada, as well as teachers and participants in exchange, co-op and work abroad programs. Since 1994, we have continually worked to exceed the expectations of our clients by offering superior service, comprehensive policy benefits and fast efficient claims processing that continue to surpass industry standards. Job Types: Full-time, Permanent Salary: $60,000.00 per year Benefits:

• Casual dress
• Company events
• Dental care
• Discounted or free food
• Extended health care
• On-site parking
• Paid time off
• Vision care
• Work from home

Schedule:

• 8 hour shift
• Monday to Friday

COVID-19 considerations:
All candidates must be fully vaccinated to be eligible and must show proof of vaccination before joining. Application question(s):

• We have a mandatory vaccination policy in place. Do you have both COVID-19 vaccinations?
• guard.me regrets that it is unable to sponsor employment visas. Are you a resident of Ontario (willing to relocate if not) with work eligibility?

Experience:

• Medical Claims Examination: 3 years (preferred)

Work Location: Hybrid remote in Markham, ON Expected start date: 2023-03-20