Claims Examiner

What you'll do

You process claim files according to company policies and procedures. This involves reviewing claims, recommending payment or denial, or requesting additional information. You process approved payments and/or denials for travellers and providers and set up payment requests from other insurers. Specifically, you will:

• Process claims according to company policies and procedures. This involves reviewing claims for completeness and compliance with policy coverage and recommending acceptance or denial of claim and expenses.
• If claim requires additional supporting documentation to confirm payability, request and review medical history, medical records, itemized bill, etc. following established SOPs. 
• Process payments and/or denials to travellers and/or providers.
• Set up requests for payment from provincial medical plans, extended health plans, and any other insurers.
• Assist Customer Service Team by providing claim information to help resolve travellers’ phone and email inquiries.
• Achieve performance targets.
• Collaborate and communicate effectively with team members and all other teams. 
• Responsively and effectively handle issues.
• Look for ways to improve customer experience.
• Promote and model TuGo culture, values, and brand promise.
• Continuously build professional and technical expertise.
• Other duties as required.

What you'll bring

• Degree or Diploma in a business-related discipline
• Successful completion of Level 2 Insurance Adjuster’s license or Level 1 General Insurance License is required within 12 months of start date
• Ability to learn and apply knowledge of policy wordings to accurately process claims 
• Strong analytical, problem solving and decision-making skills, detail-oriented and well organized
• Excellent communication/customer service skills, particularly by phone and email
• Excellent written and verbal communication skills
• Fluency in French preferred or an additional language such as Spanish, Mandarin or Cantonese is an asset 
• Previous experience assessing claims is an asset
• Experience in customer service is an asset
• Ability to multi-task
• Strong interpersonal, and conflict resolution skills
• Knowledge of medical terminology an asset
• Criminal record check is a requirement of the position as required by insurance councils for licensing
• Strong team player and positive contributor
• Proficient in MS Office Suite and able to learn applications quickly
• Able to consistently live our values of valued, effective and trusted
• A strong customer experience focus
• A passion for continuous learning and professional achievement