Story Behind the Need

• Business group: Mortgage Creditor Insurance business group - This position will support our Mortgage Creditor Insurance team by conducting intake calls, client calls, medical requests and some other duties for that block of business. This will allow our Adjudicators to focus on claims mail handling within SLA.

• Project: N/a BAU

Job Description

The main function of a claims adjudicator is to obtain information from insured or designated persons for purpose of settling claims with the insurance carrier.

Typical Day in Role

Organize and work within claim system to access client information while conducting initial intake calls with claimants, updating claims tasks, review of simple forms and submitting medical requests Prepare and review insurance claim forms and related documents for completeness.

Provide customer service, such as giving limited instructions on how to proceed with claims or providing referrals to other facilities or contractors.

Review claims to determine initial coverage eligibility and send appropriate communication to claimants Provide high quality, cost effective adjudication services which meet or exceed expectations provided to customers and are in accordance with the terms outlined in the Certificate of Insurance.

Summarize employment and mortgage lender documents.

Prepare all written correspondence, including request for additional information, communication of decisions, etc.

Meet objectives and service standards by working with the Manger to ensure that the team goals are met.

Other duties as assigned, may include reporting and other tasks to support the claims adjudicators

Candidate Requirements/Must Have Skills:

1) Fully Bilingual in French and English

2) Exceptional Communication Skills: Proficient in both verbal and written communication for diverse internal and external audiences.

3) Proficiency in Microsoft Office 365: Strong working knowledge of the Office 365 suite of programs.

4) Detail-Oriented with Quick Assessment Skills: This role requires a keen eye for detail, as it involves reviewing receipts, extracting data, and accurately inputting information into the system. An analytical mindset is essential to understand and make decisions based on the information presented.

5) Ability to deal with sensitive and confidential information.

Soft Skills:

• Excellent customer service skills.

• Excellent interpersonal skills with exceptional oral and written communication skills.

• Ability to respond constructively and decisively in high pressure or emotional situations and to respond quickly and positively to change.

• Personal style should reflect the high level of professionalism which client projects to our customers.

• Ability to work independently and as part of a high functioning team.

• Excellent time management and organizational skills

Nice-To-Have Skills:

- Previous experience in adjudicating Life and/or Disability claims is an asset.

- Good working knowledge of medical conditions and terminology is an asset.

Education:

• High school diploma or GED required. Post secondary education preferred or equivalent work experience

Best vs. Average: Outlined personal attributes/experience/skillsets that make for the ideal candidate A candidate who does not have experience/exposure to customer service would not be a fit. Ideal candidate is personable, able to communicate well and demonstrate exceptional customer service. Previous experience in insurance/ claims adjudication would be an asset.