InsuranceHires

Overview

Position: Claim Administrator

Reports to: Director, Underwriting and Risk

Flexible Work Options Available: We are a hybrid workplace environment, granting team members the ability to work up to 3 days remotely per week.

POSITION SUMMARY

The Claim Administrator will administer Life, Critical Illness, Accidental Death & Dismemberment, and Long-Term Disability claims within established timeframes and within the scope of the policy, while ensuring excellent customer service for our Members.

KEY RESPONSIBILITES

• Administer a caseload of new and ongoing Life, Critical Illness, Accidental Death & Dismemberment and Long-Term Disability claims including recording new claim notifications and gathering information, advising Adjudicator of claim situation, recording decision in administration system, and requesting payment of claim

• Manage the claim notification process including updating various systems and maintaining the claims register, sending out claims requirements and ongoing follow up for outstanding requirements

• Assess claim submission documents for completeness of information, as well as determining which applicable plan provisions may apply and follow-up accordingly

• Communicate with a variety of internal and external stakeholders to gather relevant information regarding health and life claims

• Answer inbound claims status related calls from Members; proficiently determine the needs of the caller then provide accurate and timely resolution

• Support communicating with claimants, beneficiaries, executors, legal representatives, and any appropriate stakeholders to keep them apprised of claim status updates and claim progression

• Communicate with various Reinsurance companies regarding the submission of claims under different reinsurance treaties

• Proactively follow-up on workflow requirements, escalating to leadership when needed

• Assist with internal and external audit by providing data in support of inquiries

• Support implementation of opportunities for improvement and business efficiencies

• Process claims related invoices as received

• Maintain confidentiality over client and corporate records and medical claim information; meet and maintain privacy and compliance guidelines

• Consistently provide exceptional service to internal and external customers by demonstrating the highest level of professionalism within all interactions

• Other duties as assigned

QUALIFICATIONS & EXPERIENCE

University or college degree/diploma in a relevant field of study

• 1-3 years of experience in a customer service and/or administration role within financial services; insurance experience strongly preferred

SKILLS & CORE COMPETENCIES

• Strong customer focus and service orientation

• Excellent organizational skills, ability to work effectively in a high-volume environment and maintain all service standards

• Able to multi-task and coordinate own work to deliver on several items in parallel

• Tech savvy with the ability to learn new software

• Strong Excel and Word skills

• Able to complete work independently and collaborate in a team environment

• Willing to seek new knowledge and tasks, question current processes, and suggest improvements

• Sound problem solving and decision-making skills

• Strong written and verbal communication skills

• Bilingual (English & French) is an asset

• Strong alignment with our organizational mission, vision, and core values