Claims Examiner/Adjuster

Cambridge, ON (On-site)

6-month contract

Review, examine, calculate and make decisions on a variety of claims in accordance with applicable policy and service standards. Required to attain performance objectives on a monthly basis.

• Reviewing, examining, calculating, and making decisions on a variety of claims received in the claims processing unit, to ensure the claim is paid under the respective policy and within the contracted timeframes.
• Conducting research via policies/flipcharts that can provide additional information needed to adjudicate claims.
• Entering notes into the computer system/databases as required.
• Facilitating stop payment requests and processing reissues accordingly.
• Placing outbound calls to customers or providers to obtain information required to adjudicate a claim.
• Creating and sending various types of professional correspondence.
• Responding to inter-departmental inquiries.
• Responding to escalations in a timely manner.

Qualifications:

• Post-secondary education
• Minimum of 6-12 months experience as a Claims Examiner or similar role.
• Ability to pay close attention to detail and multi-task.
• Possess sound judgment and good decision-making skills.
• Fluency in French is preferred.