Claims Examiner

Job Description

Job Description

Company Overview

Epic Health Solutions boasts over 35 years of experience in the healthcare industry, providing innovative solutions in an ever-evolving marketplace. As part of an award-winning enterprise group, we are proud to support a global team of more than 500 employees dedicated to enhancing healthcare services.

Summary

We are seeking a detail-oriented Claims Examiner to join our team at Epic Health Solutions. In this role, you will be responsible for accurately entering and managing data within our systems, contributing to the efficiency and effectiveness of our healthcare solutions. This position is essential for maintaining the integrity of our databases and supporting our operational goals.

Key responsibilities

• Review and evaluate Travel Insurance claims, supporting documents, and medical records
• Adjudicate claims in accordance with policy wording, internal guidelines, and regulatory requirements
• Communicate claim decisions clearly and professionally to insured clients and service providers
• Prepare detailed claim notes, correspondence, and denial letters as required
• Request additional information when needed and follow up with clients or providers
• Maintain accurate reserves and ensure timely updates to the claims management system
• Collaborate with internal teams to resolve complex cases and support service excellence
• Participate in quality reviews, training and continuous improvement initiatives

Qualifications

2-3 years of experience in Insurance claims (Travel, Health, or related field)

Bilingual : Fluent in English and Spanish (spoken and written)

Strong understanding of travel insurance policies and benefits (an asset)

Excellent analytical, problem-solving and decision-making skills

Attention to detail and accuracy

Strong written and verbal communication skills

Ability to prioritize tasks and manage deadlines in a fast-paced environment

Proficiency with MS Office

Core Competencies

Claims Adjudication

Customer Service Excellence

Accuracy and Attention to detail

Communication

Time management

Accountability

Problem solving

Teamwork

Professionalism

If you are passionate about insurance and want to contribute to meaningful healthcare solutions, we invite you to apply today and become a part of our dedicated team at Epic Health Solutions!

Job Type : Full-time

Expected hours : 40 per week

Benefits :

Dental care

Employee assistance program

Extended health care

Life insurance

On-site parking

Paid time off

RRSP match

Vision care

Schedule :

8 hour shift

Day shift

Monday to Friday

Work Location : Hybrid

Language requirements : English and Spanish

Epic Health Solutions is committed to providing an inclusive and accessible work environment. We are in compliance with the Accessibility for Ontarians with Disabilities Act (AODA) and are dedicated to ensuring equal opportunities for all applicants. If you require any accommodations during the recruitment process, please send us an email on and we will work with you to meet your needs.