Bilingual Claims Care Analyst

Description

What you will do

• Evaluate claims to determine eligibility for benefits by reviewing all relevant documentation, including contractual, medical, functional capacity, and occupational information, in accordance with established procedures and policy provisions;
• Effectively manage an active caseload while ensuring compliance with customer service standards, best practices, performance metrics, and processing timelines;
• Document claims analyses thoroughly and maintain accurate records in accordance with company policies and procedures;
• Communicate professionally and empathetically, both verbally and in writing, to inform stakeholders, clarify claim statuses, and explain decisions;
• Conduct in-depth telephone interviews with clients or involved parties to gather information and discuss claim outcomes;
• Identify required supporting documentation for current or future benefit payments and ensure diligent follow-up to obtain necessary information;
• Collaborate with team members, plan sponsors, and other stakeholders to uphold service standards and contribute to a positive and dynamic work environment;
• Actively participate in departmental projects and continuous improvement initiatives by identifying opportunities to optimize processes and adapting to change.

What you will bring

• Post-secondary education or equivalent work experience; a college diploma (DEC) in a relevant field is considered an asset;
• Professional designations such as FLHC, FLMI, or ALHC are an asset;
• Minimum of one (1) year of experience in insurance claims adjudication, particularly in life, disability, and critical illness;
• Medical knowledge acquired through claims adjudication, underwriting, or experience in a medical or paramedical field is considered an asset;
• Strong analytical and problem-solving skills, with attention to detail and a commitment to delivering high-quality service;
• Strong proficiency in English, required to communicate with clients and colleagues;
• Proficiency in French to communicate with clients and/or colleagues in Quebec;
• Ability to conduct sensitive telephone interviews with tact and professionalism;
• Proficiency in Microsoft Office Suite (Word, Outlook) and claims management systems;
• Ability to manage multiple priorities simultaneously and meet varying deadlines;
• Professionalism under pressure, with the ability to handle stressful situations and communicate difficult decisions with empathy;
• Positive attitude, strong team spirit, and adaptability to organizational change.

Why join?

• Flexible work arrangements with monthly financial allocations to support your work-life balance;
• Generous starting paid vacation time, plus additional vacation days for every year of service;
• Paid volunteer day so you can dedicate time to a cause you are passionate about;
• Paid personal and wellness days to support your total wellbeing;
• Educational assistance of up to $3,500 a year (with approval from your manager);
• Flexible health and wellness account (in addition to comprehensive drug and dental coverage) to help pay for a wide range of wellbeing services that are meaningful to you;
• Up to 14% of combined contributions to the RRSP matching program;
• Family-friendly maternity/parental leave and,
• Many more benefits, perks and programs.