Job Description

One of our major Banking clients is looking for an Insurance Claims Examiner (Call Center, Bank, Alias)
Length: 6 months contract with the possibility of extension and conversion to full time employment
Location: Toronto, ON (Hybrid) - Monday/Thursdays in office
Working Hours: 8:30 am - 5 pm
Line of Business: Claims
Estimated Start Date: August 8th, 2024\'The start date of this job is flexible and in order to find the best candidate the job may remain open much longer than the date mentioned on this posting... or you may be asked to start sooner than the expected start date if you are able to do so !\'Please read the job description below. If this interests you, please send a MS-Word version copy of your resume (ASAP) along with a telephone contact number: E-mail to talent@teamrecruiter.comPlease mention the job title above in the subject line
The recruiter in charge of this role is SanAfter you have submitted your resume via e-mail please complete the application for this specific job by clicking \'Submit Your Resume for this Job\' at the bottom of this page to match your resume to the job.If you are interested in further opportunities, why not also do a general registration in our database. By visiting our website and clicking on \'Database Registration\'If you do not think you are a match for this opportunity, but know someone who is, feel free to forward this email to them and you will be eligible for a referral bonus upon a successful hire.
Requirements:
ROLE MANDATE:
The selected candidate will administer the initiation and set up of claims for Life, Accidental death & dismemberment, well woman, individual disability insurance, critical illness and group insurance products. They will provide effective & efficient service and delivers the desired experience to policyholders, brokers, agents, claimants by answering incoming calls and managing general questions for a varied range of insurance products. Provides administration support in setting up new incoming claims, ensuring that all required information is received or requested. Answers questions (premium payments, eligibility) from policyholders, brokers, third party administrators and claimants related to the Group Insurance Products (LTD, STD, Life Insurance, CI & AD&D). Assesses claims based on their individual merit and adjudicates in a fair manner up to designated limit. Produces reports including time service, Group experience reports and monthly reports for all product lines.GROUP CULTURE:
This is a very collaborative team made up of 5 other administrative claims examiners.ROLE RESPONSIBILITIES (including but are not limited to):
Collaborates with internal and external stakeholders in order to deliver on business objectives
Gathers and formats data into regular and ad-hoc reports, and dashboards
Analyzes data and information to provide insights and recommendations
Acknowledges receipt of new claims and request outstanding information for new claims, incomplete claims and approved claims to support processing and monitor ongoing to ensure all information is received
Sets up new incoming claims in the appropriate system for reported claims as required based on the client need & product requirements and send out applicable acknowledgement letters
Advises POS for Agency claims when a death occurs to stop premium payments
Partners with internal stakeholders in Agency and Direct to initiate new claims set up, monitor workflow to ensure that claims meet servicing turnaround time for adjudication process
Manages daily cheques for group claims by printing off cheque run information and distributing it to appropriate internal stakeholders
Scans identified claim files as part of front-end imaging
Provides business partners with monthly copy of the expense payment report
Answers incoming calls by policyholders, brokers, agents, beneficiaries, and claimants in an efficient and effective manner delivering the desired client experience by assisting with general questions and initiating claims forms for all products
Answers administrative questions from Group policyholders, insured\'s, brokers, third part administrators and claimants
Adjudicate assigned claims for multiple products, including investigating claim details to determine validity, conducting telephone interviews, consulting with medical consultants and legal resources, coordinating independent assessments, analyzing financial information, documenting detailed case management action plans, making eligibility decisions, re-evaluating claims being appealed, initiating detailed and complex rehabilitation plans, communicating decisions verbally and in writing as required, and signing to release payments
Manages assigned case load in an effective manner, escalating any issues or concerns, to ensure ongoing effective claim operations
Addresses any claimant or policyholder issue as part of the conversation, escalating as required for any complaint situation
Follows established policies & procedures including authority and signing authority to manage the risks inherent in claims operations and escalate any issues or concerns
Participates in quality reviews addressing any issues identified to help reduce risk inherent in claims operations
Follows appropriate guidelines in addressing client concerns and complaints, including documentation of claims to the Complaint\'s Ombudsman
Completes complex & diverse tasks within given rules/limits and may include handling escalations from other employees
Analyzes issues and determines next steps
Broader work or accountabilities may be assigned as neededQualifications:
SKILLS:
2-3yrs relevant experience
Knowledge of insurance products, contracts and benefit plans (all individual, disability and group products)
Previous experience with Life and Critical Illness insurance a strong asset
Previous customer call center experience is preferred
Stakeholder management
Professional demeanor and email etiquette
Proficient in MS office
Multitasking
Detail oriented
Time management and experience working in high volumes
Fast learner and independent worker
Experience with claims management systems and/or Alias an asset
Verbal & written communication skills - Good
Organization skills - Good
Collaboration & team skills - Good
Analytical and problem-solving skills - Good
Previous banking experience an assetINTERVIEW PROCESS:
First Round - 30min Teams meeting with HM
Possible 2nd round pending 1st rounds
Format will consist of behavioral and getting to know you type questionsPlease note that this is the most up to date version of job description available at this time - During Client Interview you will receive additional information - variance may apply!When you have some time please register in our database (5 minutes process) to be considered for future openings; the link is available on our website at http://www.teamrecruiter.com in the Candidate section. Please follow us on LinkedIn at https://www.linkedin.com/company/teamrecruiter.com/, or on Twitter at https://twitter.com/TeamRecruiter.We thank all applicants for their interest. Only those who meet the qualifications will be contacted through telephone/email. You are encouraged to register with us in our database to be considered for future positions available.Have a great day.At Teamrecruiter.com we offer some of the most highly qualified professionals in the workforce. We dedicate an industry trained recruitment specialist to the following areas: IT, Finance, Admin, Sales, Executive Search and Contractors. If you would like to learn more about our full-service recruiting firm please visit our website at www.teamrecruiter.com.CAMSC and ACSESS certified"...All Offers are conditional on Client Post-Offer Conditions being met and removed by end client prior to written offer signing""Please note that emails from our Recruitment Firm may inadvertently be sent to your Spam Folder. When contacted regarding an employment opportunity, please keep an eye on your Spam/Junk Folder to avoid missing important communication."THE EMPLOYER OF RECORD FOR THIS ROLE WILL BE TEAM RECRUITER / SE.Accommodations are available upon request for all individuals with disabilities taking part in the recruitment and selection process.

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