Reports to
Manager, Group Health Claims
Location
Waterloo, Ontario
Job Status
Temporary, Full-Time (Until December 2017)

This Health Claims Adjudicator role provides a great opportunity for someone who is looking for a career that involves providing excellent customer service to internal and external customers in a medical-related field. The objective of the role is to Adjudicate Health Claims effectively and provides back up to resolve health phone calls/inquiries from customers (plan members, plan sponsors, advisors, GMMs, and external vendors).

Accountabilities:

  • Adjudicate health claims received within the appropriate guidelines and within the published service standards
  • Provide quality customer service to Policyholders, Group Offices, Head Office staff and Medical Providers, using a thorough knowledge of the claims area; the majority of the time involves adjudicating Health Claims..
  • Work with the Special Investigations Unit by identifying suspicious claims and alerting the department to the findings.
  • When required, provide clear and concise communication concerning all claim decisions both verbally over the phone and in writing if required.
  • Contribute to the continuous improvement of business processes.
  • Develop and maintain a solid knowledge of: related legislation and Company practice; of policies currently and previously marketed by the Company.
  • Interpret and apply contract provisions and administrative guidelines to determine eligibility and reasonable and customary charges for medical claims.

Qualifications:

  • Dental and Medical terminology and related education.  Post-secondary education preferred including dental assistant, pharmacy assistant, massage therapy, medical assistant, etc.
  • Previous Claims Adjudication experience
  • Superior interpersonal skills to manage relationships with internal and external clients.
  • Excellent listening skills to facilitate positive outcomes with inquires and irate callers.
  • Ability to handle high stress levels in a fast paced production environment.
  • Strong change management skills including Adaptability and Flexibility.
  • Ability to work effectively in a team environment.
  • Excellent verbal and written communication skills.
  • PC skills – working knowledge of MS office, MS Access, and keyboarding.

 

 

How to Apply

To apply for this position, please email your cover letter, including salary expectations, and resume in one MSWord document to resumes@equitable.ca

If applying to multiple positions, please apply to each position separately.

At Equitable Life, we are committed to providing equal access to employment opportunities across our organization. Please contact our HR team at resumes@equitable.ca if you require an accommodation with the application process, including for a request to receive our job postings in an alternative format.