Job Description

Position Type:
Permanent

If you're looking for a fulfilling career that can make a real difference in your life, and the lives of others, you've come to the right place.

As a national health solutions partner, we put people first in everything we do - and that begins with our team of 8,000+ professionals who bring a cross-section of diverse life experiences and career expertise to Medavie. By collaborating and innovating together, our employees are creating industry-leading solutions in insurance, primary care and emergency medical services that impact millions of lives in Canada each year.

Our mission is to improve the wellbeing of Canadians so that every life can be lived to the fullest - and it's reflected in our award-winning culture. We celebrate individuality and value the diverse perspectives and skills our employees contribute. We go beyond providing competitive pay and comprehensive benefits to offer opportunities for personal and professional growth, flexible work options, meaningful experiences, and supportive leadership. Medavie is where employees can be their best selves, feel they belong, and achieve their full potential. Be part of it by applying for a position with us today.

As a Sr. Life & Critical Illness Claims Specialist within the Case Management Services team, you will be working and collaborating with a team of talented professionals in a fast-paced work environment to ensure service level standards are met. This position requires a bilingual candidate in both French and English to work on Atlantic, Ontario and Quebec accounts.

This role is focused on the adjudication of Life, AD&D & Critical Illness claims and will require communication and collaboration with other team members as well as group administrators to ensure all information is obtained in a timely fashion leading to appropriate claim decisions.

Key Responsibilities

• Life, AD&D and Critical Illness claims adjudication: reviewing coverage eligibility, assessing contractual definitions through medical information, identifying beneficiaries, telephone contacts, sending letters and paying the claims.
• Communicate with doctors when required to obtain information that is relevant to the claim.
• Prioritize and maintain workload to meet turnaround standards and ensure a positive customer experience.
• Accurately document case management plan, decision, and payment of claim.
• Apply provincial legislations to various claims scenarios.
• Effective and consistent use of an electronic case management software.
• Build effective relationships with colleagues and stakeholders such as group administrators and claimants.
• Render decision on a timely basis and effectively communicate these decisions, at times potentially difficult decisions and manage escalations with employers and claimants.

Required Qualifications

Education :

• A post-secondary education.

OR

Work Experience :

• Experience in insurance claims; experience directly with Life, AD&D, Critical Illness or Disability considered an additional asset.

Other Qualifications

• Strong written and verbal communication skills to successfully partner with different stakeholders including the claimant, their treatment providers and physicians, the employer, group administrators, human resources, and lawyers.
• Excellent customer service and telephone skills and the ability to communicate complex and difficult information clearly with tact and sensitivity.
• A general understanding of the health care and insurance fields and health related terminology.
• Motivation to learn, ability to multitask, excellent organizational skills.
• An understanding of contract wording and the ability to thoroughly review medical reports and other types of documents.

Computer Skills :

• Strong computer skills in the Microsoft Suite of products and ability to learn a claims management software. Experience working with an electronic case management software is an asset.

Language Skills :

• Strong verbal and written communication skills in both official languages (ENG/FR) with the ability to communicate clearly and concisely.

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We believe our employees should reflect the communities we serve and welcome applications from candidates of all backgrounds. To provide the best experience possible, we will support you with accommodations or adjustments at any stage of the recruitment process. Simply inform our Recruitment team of your needs. We are committed to making sure recruitment, retention, advancement, and compensation are fair and accessible while following all relevant human rights and privacy laws . We appreciate everyone who has shown interest in this position. Only those selected for an interview will be contacted.

If you experience any technical issues throughout the application process, please email: [email protected] .

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