Claims Examiner
National Healthcare Solutions Group LLC•Markham, ON
•CA$40,000 - CA$45,000•Hybrid
About The Position
We are seeking a detail-oriented, bilingual Claims Examiner to join our Travel Insurance team at Epic Health Solutions. In this role, you will review, investigate, and adjudicate travel insurance claims while communicating professionally with insureds, brokers, and medical facilities in both English and Portuguese. This position is essential to maintaining claims accuracy and supporting our operational goals.
Requirements
- 2-3 years of experience in claims examining or adjusting insurance claims (Travel, Health, or related field)
- Bilingual fluency in English and Portuguese (spoken and written) required; must be able to professionally read, write, and speak with agents, medical facilities, and brokers in both languages
- Excellent analytical, problem-solving, and decision-making skills
- Strong attention to detail and accuracy
- Strong written and verbal communication skills
- Ability to prioritize tasks and manage deadlines in a fast-paced environment
- Proficiency with MS Office
Nice To Haves
- Strong understanding of travel insurance policies and benefits considered an asset
Responsibilities
- Review, investigate, and adjudicate Travel Insurance claims (Medical, Trip Cancellation/Interruption/Delay, Baggage Loss/Damage/Delay) in accordance with policy terms and conditions
- Communicate effectively and professionally in both English and Portuguese with insureds, agents/brokers, medical facilities, and other stakeholders to collect documentation and explain claim status and decisions
- Analyze medical records and other supporting evidence to determine coverage and validity of claims
- Respond to claim inquiries and complaints from insureds and brokers in a timely, courteous manner
- Maintain accurate reserves and ensure timely updates to the claims management system
- Draft clear, accurate, and compliant claim denial letters that cite applicable policy language, in both English and Portuguese as needed
- Participate in quality reviews, training, and continuous improvement initiatives
- Perform other duties as assigned
Benefits
- Dental care
- Employee assistance program
- Extended health care
- Life insurance
- On-site parking
- Paid time off
- RRSP match
- Vision care
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
