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Bilingual Specialty Claims Adjudicator

Insurance


Capgemini

Dartmouth, Nova Scotia

Job Description

Job Title:                   Bilingual Specialty Claims Adjudicator
Department:           Claims
Reports To:              Team Lead
Job Location:          120 Eileen Stubbs Avenue, Dartmouth, Nova Scotia     
Job Type:                  Full time, Permanent

Summary

The Specialty Claims Adjudicator is responsible for the timely and accurate adjudication of Life/Specialty claims including but not limited to, critical illness, personal accident, waiver of premiums and long term care.

Essential Duties and Responsibilities:

  • Provide Superior Customer Service to our Policy Holders and Agents
  • Act on client requests for information and settlement,  along with urgent and complex cases, taking appropriate action in accordance to the request and policy terms to assure Policy Owner satisfaction.
  • Adherence to standard operating processes and procedures and quality guidelines
  • 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.
  • Resolves escalated/complex policyholder and/or broker issues
  • Operate within company and legal regulations regarding PIPEDA, fraud, confidentiality, and private health information.​

Qualifications 

To perform this job successfully, the individual must be able to perform each essential duty effectively.  The individual must possess;

  • Minimum 2 years Life insurance administration experience
  • Proficient in Microsoft Office tools – Word, Excel, Access, PowerPoint, SharePoint
  • Excellent interpersonal abilities are required to enable effective interaction and communication in both oral and written format with employees, policyholders, employers and other insurance/medical/legal professionals
  • The ability and willingness to learn multiple computer systems
  • Strong analytical and decision making skills
  • Ability to multi task
  • Ability to effectively manage change
  • Organizational skills
  • Demonstrated ability to work well in a team environment
  • Ability to adapt and update ones knowledge and skills in an ever changing environment
  • Willing to learn new tasks and systems as required
  • Knowledge and understanding of life and health insurance

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

  • High school diploma
  • Post-Secondary College / University Degree or equivalent is an asset

Language Skills

Ability to

  • Read and interpret documents such as policies and operating and procedural manuals. 
  • Write routine correspondence.to insured’s, medical and legal staff
  • Speak effectively and professionally to clients, external stakeholders and employees of the organization.

Fluency in spoken and written English and French is required.

Competencies

  • Critical thinking, customer service skills, time management, problem solving, decision-making, interpersonal skills and adaptability/flexibility.

Mathematical Skills

  • Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.  Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages and volumes.

Reasoning Ability

  • Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. 
  • Ability to deal with problems involving a few concrete variables in standardized situations.

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