Insurance Claims Administrator (Life, Critical Illness, Disability)

Our Banking client is looking for an Insurance Claims Administrator (Life, Critical Illness, Disability)Length : 6 months contract with the possibility of extension and conversion to full time employmentLocation : Toronto, ON (Hybrid) - Monday / Thursdays in officeWorking Hours : 8 : 30 am - 5 pmLine of Business : ClaimsEstimated Start Date : October 14th, 2024ROLE MANDATE : The selected candidate will administer the initiation and set up of claims for Life, Accidental death and dismemberment, well woman, individual disability insurance, critical illness and group insurance products.

They will provide effective and efficient service and delivers the desired experience to policyholders, brokers, agents, claimants by answering incoming calls and managing general questions for a varied range of insurance products.

Provides administration support in setting up new incoming claims, ensuring that all required information is received or requested.

Answers questions (premium payments, eligibility) from policyholders, brokers, third party administrators and claimants related to the Group Insurance Products (LTD, STD, Life Insurance, CI & AD&D).

Assesses claims based on their individual merit and adjudicates in a fair manner up to designated limit. Produces reports including time service, Group experience reports and monthly reports for all product lines.

GROUP CULTURE : This is a very collaborative team made up of 5 other administrative claims examiners..ROLE RESPONSIBILITIES (including but are not limited to) : · Collaborates with internal and external stakeholders in order to deliver on business objectives· Gathers and formats data into regular and ad-hoc reports, and dashboards· Analyzes data and information to provide insights and recommendations· Acknowledges receipt of new claims and request outstanding information for new claims, incomplete claims and approved claims to support processing and monitor ongoing to ensure all information is received· Sets up new incoming claims in the appropriate system for reported claims as required based on the client need and product requirements and send out applicable acknowledgement letters· Advises POS for Agency claims when a death occurs to stop premium payments· Partners with internal stakeholders in Agency and Direct to initiate new claims set up, monitor workflow to ensure that claims meet servicing turnaround time for adjudication process· Manages daily cheques for group claims by printing off cheque run information and distributing it to appropriate internal stakeholders· Scans identified claim files as part of front-end imaging· Provides business partners with monthly copy of the expense payment report· Answers incoming calls by policyholders, brokers, agents, beneficiaries, and claimants in an efficient and effective manner delivering the desired client experience by assisting with general questions and initiating claims forms for all products· Answers administrative questions from Group policyholders, insured's, brokers, third part administrators and claimants· Adjudicate assigned claims for multiple products, including investigating claim details to determine validity, conducting telephone interviews, consulting with medical consultants and legal resources, coordinating independent assessments, analyzing financial information, documenting detailed case management action plans, making eligibility decisions, re-evaluating claims being appealed, initiating detailed and complex rehabilitation plans, communicating decisions verbally and in writing as required, and signing to release payments· Manages assigned case load in an effective manner, escalating any issues or concerns, to ensure ongoing effective claim operations· Addresses any claimant or policyholder issue as part of the conversation, escalating as required for any complaint situation· Follows established policies and procedures including authority and signing authority to manage the risks inherent in claims operations and escalate any issues or concerns· Participates in quality reviews addressing any issues identified to help reduce risk inherent in claims operations· Follows appropriate guidelines in addressing client concerns and complaints, including documentation of claims to the Complaint's Ombudsman· Completes complex and diverse tasks within given rules / limits and may include handling escalations from other employees· Analyzes issues and determines next steps· Broader work or accountabilities may be assigned as neededSKILLS : · 2-3yrs relevant experience· Knowledge of insurance products, contracts and benefit plans (all individual, disability and group products)· Previous experience with Life and Critical Illness insurance a strong asset· Previous customer call centre experience is preferred· Stakeholder management· Professional demeanor and email etiquette· Proficient in MS office· Multitasking· Detail oriented· Time management and experience working in high volumes· Fast learner and independent worker· Experience with claims management systems and / or Alias an asset· Verbal & written communication skills - Good· Organization skills - Good· Collaboration & team skills - Good· Analytical and problem-solving skills - Good· Previous banking experience an assetINTERVIEW PROCESS : · First Round - 30 minutes Teams meeting with Hiring Manager· Possible 2nd round pending 1st round· Format will consist of behavioral and getting to know you type questions URGENT : Please read the job description above.

If this interests you, apply to the job with your most updated resume, including your contact number and email address.The recruiter in charge of this role is San.

If you do not think you are a match for this opportunity, but know someone who is, feel free to forward this job description to them and you will be eligible for a referral bonus upon a successful hire.

Please note that this is the most up to date version of job description available at this time - During Client Interview you will receive additional information - variance may apply!Please note : Adherence to our end client's vaccination policy is a requirement.

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