Bilingual Claims Adjudicator
Resolve Recruit
East York, ON, Canada
2d ago

As a Member of the Claims Service team this position is responsible for the assessment and payment of death claims while adhering to all regulatory and policy contract provisions.

Responsibilities :

  • Responsible for the adjudication of death claims : collects and reviews all relevant information to determine legitimacy, eligibility and benefit amount payable
  • Performs all required calculations and ensures all activities are in compliance with legal and TPA client’s standards
  • Communicates verbal and written information as appropriate to those with a need to know. Ensures information is clear, accurate and consistent with all legal, privacy, confidentiality and company standards.
  • Follows through on all outstanding items in a timely basis as per service level agreements. Commitment to take ownership and to resolve client issues and concerns to the satisfaction of the client and business unit.
  • Refers questionable / contentious claims to management and / or TPA client for evaluation as needed and provide recommendation for actions.
  • Maintains and updates all applicable system records
  • Experience / Skills :

  • Minimum 3 years’ experience in adjudication including the investigation and detailed reporting of life insurance claims
  • Demonstrated mathematical aptitude and strong data analysis skills with attention to detail and accuracy.
  • Understanding of Canadian Life insurance products and applicable insurance laws
  • Good verbal and written communication skills to effectively communicate with internal and external customers / partners and vendors.
  • Critical thinking, customer service skills, time management, problem solving, decision-making, interpersonal skills and adaptability / flexibility.
  • Pursuing ALHC, FLMI or ACS
  • Must be able to work independently with little supervision in a team environment.
  • Required education : Bachelor's
  • Required experience : life insurance : 4 years
  • Required language : French
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