Bilingual Claims Examiner

Summary:

After 6 months of training in our office in Richmond BC, this position can be performed remotely from home up to 4 days/week. You will process claim files according to Company policies and procedures. This involves reviewing claims, recommending payment or denial, or requesting additional information. You will process approved payments and/or denials for travellers and providers and set up payment requests from other insurers.

Specifically you will:

• Process claims according to Company policies and procedures. This involves reviewing claims for completeness and compliance with policy coverage and recommending acceptance or denial of claim and expenses.
• If claim requires additional supporting documentation to confirm payability, request and review medical history, medical records, itemized bill, etc. following established SOPs.
• Process payments and/or denials to travellers and/or providers.
• Set up requests for payment from provincial medical plans, extended health plans and any other insurers.
• Assist Customer Service Team by providing claim information to help resolve travellers’ phone and email inquiries.
• Provide backup and support for Medical Assistance Team for calls related to hospitalizations.
• On occasion, may act as liaison between TuGo’s medical staff and insured, family etc.
• Achieve performance targets.
• Collaborate and communicate effectively with team members and all other teams.
• Responsively and effectively handle issues.
• Look for ways to improve customer experience.
• Promote and model TuGo culture, values, and brand promise.
• Continuously build professional and technical expertise.
• Other duties as required.

• Degree or Diploma in a business-related discipline
• Verbal and Written fluency in French & English
• Level 2 Insurance Adjuster’s license or Level 2 General Insurance License is an asset
• Ability to learn and apply knowledge of policy wordings to accurately process claims
• Strong analytical, problem solving and decision-making skills, detail-oriented and well organized
• Previous experience assessing claims is an asset
• Experience in customer service role is an asset
• Ability to multi-task
• Strong interpersonal, and conflict resolution skills
• Knowledge of medical terminology an asset
• Criminal record check is a requirement of the position as required by insurance councils for licensing
• Once fully trained, work schedule will include some non-business hour shifts (weekend and evening shifts)
• Strong team player and positive contributor
• Proficient in MS Office Suite and able to learn applications quickly
• Able to consistently live our values of valued, effective and trusted
• A strong customer experience focus
• A passion for continuous learning and professional achievement