Senior Claims Assessor ( Medical claims)

Global Excel Management•Windsor, ON

About The Position

The Claims Assessors in Claims Management are contributing to cost containment efforts by validating claims for authenticity, investigating legitimacy of documentation received and requesting missing information in order to direct the claim to the appropriate process or outcome and issue reimbursements where applicable. A Senior Claims Assessor is also responsible for supporting the Assessment team through taking ownership of complaint or complex files, assisting with training, and coaching and handling other administrative tasks that may be required to ensure team quality and efficiency targets are met.

Requirements

College diploma or equivalent
One to two years’ experience in a customer service-related position
Knowledge of Medical claims process
Excellent analytical skills
Excellent verbal and written communication skills in English, French is an asset
Strong decision-making and organizational skills
Autonomous, professional and detail-oriented
Proficiency in Microsoft suite office products and knowledge of SharePoint

Nice To Haves

French is an asset

Responsibilities

Review claim communication and documentation to ensure legitimacy and claim authenticity
Investigate claim validity prior to settlement by communicating with third parties including travel suppliers when applicable
Review applicable policy wording and corporate client guiding principles to accurately apply proper benefits, policy maximums and exclusions
Communicate with customers to request missing information
Effectively utilize claims system to track claim progression and customer communication
Render decisions on claim outcomes and issue payments or denials
Take ownership of complaint or complex files, including potentially fraudulent claims, and follow through until claim settlement
Handle escalated calls and/or emails to ensure the claim or issue is resolved or escalated accordingly
Provide technical training, coaching and conduct audits for Claims Assessors where needed and as required by the Team Leader
Complete other administrative tasks as delegated by the Team Leader and as per business needs including but not limited to completing team reports, monitoring the Help Desk mailbox, etc.