Claims Examiner at MSH INTERNATIONAL CANADA LTD. – Toronto, Ontario

You are an experienced Claims Examiner who can handle a large case load, multi-task, and meet tight deadlines. You thrive in a fast-paced environment providing excellent customer service in both the turnaround of the claim and handling emails and incoming calls. You will have the desire to develop an in-depth understanding of this position and be able to easily maneuver through numerous policies to accurately assess claims and inquiries. You are a very strong team player.

The Claims Examiner will be responsible for processing a variety of different claims and communicating these decisions to providers, members, and clients. This role requires strong time management skills, claims experience, and policy interpretation.

Responsibilities

• Process health, dental and vision claims up to the designated limit
• Adjudicate claims according to various benefit policies
• Provide excellent customer service for claims matters both in person and via written correspondence
• Handle both inbound and outbound calls to members and health providers as required
• Work closely with both the Assistance and Finance departments, as well as other departments on a day-to-day basis
• Ensure all work complies with the PIPEDA and HIPAA
• Support department initiatives that increase revenues, save costs, and meet company objectives
• Maintain concise file documentation consistent with corporate policies
• Adjust reserves to ensure that reserve activities are consistent with corporate policies
• Provide overall portfolio management of assigned claims files
• Develop action plans and report claim progression on a regular basis
• Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures
• Present cases and participate in discussions during department meetings
• Provide guidance and mentorship to peers
• Participate in client implementations and projects where required
• Other related duties as assigned

Qualifications and Education Requirements

• High school diploma or equivalent
• Experience in the travel insurance industry is required
• Minimum 2-3 years of relevant Canadian claims processing experience
• Experience in processing health, dental, and vision claims
• High level of proficiency in Microsoft Office suites, specifically Excel
• Superior verbal and written communication skills
• Strong time management and organizational skills
• Strong analytical and problem-solving skills

Preferred Skills

• Snowbird, expatriate insurance, TPA experience
• Cost containment/provider relations experience
• Experience with medical coding standards
• Dispute resolutions experience
• GHIP recovery/coordination of benefits/subrogation
• Experience in handling US medical invoices/claims