Investigative Claims Representative
Sun Life
Montreal, Quebec
5d ago

At Sun Life, we work together, share common values and encourage growth and achievement. We offer many career paths that attract a wide variety of talent and skills.

Follow a path that lets your talents shine.

Job Description :

The Investigative Claims Representativeis an important front line of defence in identifying potentially fraudulent activity submitted through Group Benefit plans.

ICRs verify claims that require further handling by Health and Dental or Fraud Risk Management, by performing pre-and post-

payment claim verifications on a selection of submitted claims through a variety of submission channels. This is achieved by placing outbound telephone calls to service providers, facilities and members in order to validate these submissions.

The team also receives incoming telephone calls through the FRM Tip Line, from the public, with information regarding possible suspicious activities.

What will you do?

  • Contacting Plan Members, Service Providers and Hospitals to validate claim submission details including service dates, amounts, and type of service rendered or purchased.
  • Managing caseload and queue volumes, continually working towards first call resolution
  • Communicating with members, practioners and hospitals utilizing the principles of clear language, and in a courteous and professional tone
  • Following up with requests for additional information from the Plan Member or Service Provider when verification cannot be obtained
  • Tracking and determining call outcomes
  • Collaborating with colleagues to drive process improvements, which have a direct impact on the client experience
  • What do you need to succeed?

  • Excellent verbal and written communication skills
  • Strong analytical and problem solving skills, and attention to accuracy and details
  • Strong organizational and decision making skills
  • Ability to complete detailed tracking of all activities to support any follow up
  • Ability to handle conflicting priorities and meet stringent deadlines
  • Ability to operate effectively as a team member in a dynamic environment
  • Ability to work independently with minimal supervision
  • Microsoft Excel experience
  • Post-secondary education preferred
  • Experience having worked in a serviced based organization
  • What's in it for you?

  • Joining a reputable organization with over 150 years of history
  • Being a member of the Sun Life family, a group of people united by our Purpose : to help Clients and Employees achieve lifetime financial security and live healthier lives
  • An environment of continuous learning and improvement
  • Please note, there are 2 positions available*
  • The Base Pay range is for the primary location for which the job is posted. It may vary depending on the work location of the successful candidate or other factors.

    In addition to Base Pay, eligible Sun Life employees participate in various incentive plans, payment under which is discretionary and subject to individual and company performance.

    Certain sales focused roles have sales incentive plans based on individual or group sales results.

    Diversity and inclusion have always been at the core of our values at Sun Life. A diverse workforce with wide perspectives and creative ideas benefits our clients, the communities where we operate and all of us as colleagues.

    We welcome applications from qualified individuals from all backgrounds.

    Persons with disabilities who need accommodation in the application process or those needing job postings in an alternative format may e-

    mail a request to thebrightside sunlife.com.

    We thank all applicants for showing an interest in this position. Only those selected for an interview will be contacted.

    Salary Range :

    33,800 / 33 800 - 48,700 / 48 700

    Job Category :

    Customer Service / Operations

    Posting End Date : 21 / 06 / 2019

    21 / 06 / 2019

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