Senior Claims Examiner (Bilingual - French/English)
About The Position
The Prior Authorization Senior Examiner, Drug Services is responsible for assessing coverage for complex medications that require prior authorization under a group drug plan. In this role, you will review medical information against established guidelines and, in consultation with the Medical Board, determine whether coverage should be approved or declined. You will then communicate decisions clearly to plan members, both verbally and in writing. This role is ideal for a detail-oriented professional who thrives working both independently and collaboratively in a fast-paced, evolving environment.
Requirements
- Living our values of Customer View; Integrity; Partnership; and Communities
- Ability to deliver high quality results with speed and accuracy in a fast paced challenging and ever changing work environment
- Strong organizational, quality and time management skills
- Excellent analytical, investigative and problem solving skills
- Strong customer service skills
- Excellent verbal and written communication skills
- Experience working in Excel, Word and Access.
- Excellent keyboarding skills of 40wpm
- At ease navigating through multiple computer programs simultaneously
- Bilingualism (fluent in French and English) required, as the position will regularly serve our clients with English and French-speaking needs.
Nice To Haves
- Knowledge of the insurance industry and exposure to drug plans will be considered an asset
- Knowledge of Sharepoint will be considered an asset
Responsibilities
- Review medical information submitted by the patient’s physician to determine if all the necessary information has been received in order to complete the assessment. If not, must correspond either verbally or in writing with either the plan member, the pharmacy, or the physician to obtain any missing information.
- Determine, based on the group plan parameters, if coverage is eligible under the group plan.
- Review the medical information and determine if further investigation with our Healthcare professionals is required or if the assessment can be made based on the information available to you.
- Correspond both by phone and in writing with plan members to advise and support the decisions made.
- Provide support to the Canada Life Group Offices, Sales & Marketing Centers, Benefit Payment Offices, and Group Customer Contact Services regarding prior authorizations.
Benefits
- Career Development: Opportunities for career advancement, access to industry-leading learning programs and up to $2,000 annually towards education reimbursement.
- Health & Wellness: Flexible health and dental benefits, plus a $5,000 mental health benefit to support your well-being.
- Time Off: In addition to regular vacation and personal days, we support community involvement with a volunteer day.
- Financial Security: Company-matching pension plan, share ownership program and additional investment options.
- Rewards and Recognition: Employee recognition programs, service milestone celebrations, employee discounts and more!
- Emphasis on Community: We provide a workplace where employees feel connected and supported through Employee Resource Groups (ERGs), mentorship programs, social clubs and events.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
