Claims Assessor

Global Excel Management • Windsor, ON

4d

About The Position

As a Claims Assessor, you’ll be evaluating and enforcing claim benefits and limitations based on a comprehensive understanding of the applicable policy wording. The claims assessor is responsible for qualifying a claim/bill for payment. Claims are reviewed for customer service and may require direct client contact. The assessors are responsible to contribute to cost containment efforts by validating bills for services rendered, authenticity and reasonable and customary charges.

Requirements

• Proficiency in Microsoft Office suite
• Bilingualism (French and English) is mandatory. Excellent written and verbal communication skills in both languages are required to review claims and client communications, primarily from outside Canada, and to collaborate effectively with teams across multiple locations.
• Excellent organizational skills with a strong attention to detail and strong decision-making skills
• Ability to adapt to on-going change and work volumes in a fast-paced, customer focused environment

Nice To Haves

• A University degree or college diploma preferred, but not required
• Experience in insurance product benefits and limitations an advantage
• Comprehension of healthcare system and billing practices an advantage

Responsibilities

• Review applicable policy wording and validate claim coverage
• Review all verbal and written communication within the file
• Review bills for rendered services, coding, and reasonable & customary charges
• Review medical information submitted for necessity of further requirements or internal specialist review
• Establish presence of claim requirements as per policy wording (i.e.: proof of payment and authenticity of bills/claims)
• Request missing claim components as required for adjudication
• Ensure creation of appropriate follow up workflows
• Provide notice of claim decision and explanation including denials via phone, formal letter, or email
• Confirm and adjust (if required) claim entries

Benefits

• Competitive compensation package that includes a base salary, performance bonus and an extensive benefits package
• A professional future with opportunities for development, growth, and advancement
• RRSP Match program
• Financial assistance to employees who wish to continue their education
• Work/life balance, health and wellness initiatives including an excellent EAP program
• Employee engagement programs that focus on fitness, food, and fun

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree