Bilingual Claims Adjudicator

Are you looking for unlimited opportunities to develop and succeed? With work that challenges and makes a difference and a flexible and supportive environment, we can help our customers achieve their dreams and aspirations.

To be successful in our claims department you must have a passion for making a difference in our customers lives! You will be a dynamic, positive, customer service focused and creative individual in your work. You will also need to have an aptitude and demonstrated ability to think outside of the box to provide solutions and identify opportunities to improve our processes and customer experience. You are a change-maker, innovative, resourceful and thrive on pushing our company forward with fresh ideas. You are hungry for success and we foster a working environment where you can grow your skills and achieve your goals.

We are currently seeking a Bilingual Claims Adjudicator for a client base across Canada. Product lines include Individual Disability, Critical Illness, Life Waiver of Premium and Long Term Care Policies. The successful candidate must be able/willing to work in a team environment and be motivated to maintain exemplary customer service to our clients. 

Responsibilities:

• Establish and maintain superior customer service to policyholders, agents, marketing centers

• Manage ongoing claims by requesting further medical, financial documentation or investigations as required and consult with specialists in all areas.

• Review claims and underwriting files for proper disclosure of past medical history, exclusions, riders, endorsements; administer policy enhancements, premium waiver and other policy benefits

• Make decisions on disability claim eligibility and communicate decisions to stakeholders

• Document the claim file to ensure an accurate record of events that transpire in the claim handling

• Obtain proper file information and review with policy provisions to verify eligibility

• Accurately maintain claim records on system to ensure accuracy of reserve calculations

What we are looking for:

• University degree in any discipline or equivalent work experience.

• 2-3+ years’ experience in adjudicating claims, preferably disability and critical illness.

• Customer service oriented individual with negotiating skills is essential.

• Bilingual (French & English) is required - The successful candidate will be required to communicate in English and French in order to support clients from various jurisdictions outside of Quebec.

• Must have a good working knowledge of medical conditions and terminology, as well as experience in the interpretation and application of financial documentation and fair claims practices.

• Ability to respond constructively and decisively in high pressure or emotional situations …