Claims Examiner

About This Role

This role involves reviewing and assessing insurance claims, making informed decisions based on policy guidelines, and ensuring claims are resolved accurately, efficiently, and with a customer-first mindset. The Claims Examiner plays a key role in delivering exceptional service to customers.

Responsibilities

• Review, analyze, calculate, and adjudicate a variety of insurance claims in accordance with policy provisions and service standards
• Investigate and evaluate claims by reviewing policies, supporting documentation, and internal systems to make accurate benefit determinations
• Maintain complete and accurate claim records, including detailed documentation and file notes
• Process payment adjustments, including stop payment requests and cheque reissues
• Proactively contact customers, providers, and other stakeholders to obtain information needed to assess and resolve claims
• Respond to customer inquiries via phone and email, addressing claim status questions and resolving issues in a professional and timely manner
• Prepare and issue professional written correspondence related to claim decisions and requests for information
• Partner with internal teams to resolve customer concerns and support efficient claim resolution
• Manage claim reserves in accordance with established guidelines and procedures
• Identify opportunities to resolve claims at the first point of contact, enhancing both the customer experience and operational efficiency
• Work effectively in an environment shaped by artificial intelligence (AI), machine learning, data analytics and cloud-based tools, using insights responsibly with our standards of data governance, security and ethical use

Requirements

• Post-secondary education or an equivalent combination of education and experience
• 6-12 months of experience in a customer service, claims, insurance, or administrative role
• Strong attention to detail and the ability to manage multiple priorities in a fast-paced environment
• Sound judgment, critical thinking, and problem-solving skills
• Ability to work independently while contributing effectively as part of a team
• Excellent written and verbal communication skills
• Ability to work in a hybrid environment, including two days per week in our Cambridge, ON office

Nice to have:

• French language skills

Benefits

• Personal and professional development through a large variety of courses and targeted development programs
• International mobility and career progression
• Work Well programs for health and wellbeing, providing peace of mind and flexibility for work-life balance