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Claims Analyst

Montreal, QC
Posted 5 days ago
Job Details:
In-person
Full-time
Experienced
Benefits:
Paid Time Off
Flexible Work

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.

Number of positions to fill : 4
Salary: 21,02$

Position Summary:

Under the Team Leader's supervision, you are responsible for processing standard or complex claims relative to your decisional level in accordance with the policies and procedures for claims payment.

You respond in writing to and follow up on internal requests for adjustments related to previously processed/submitted transactions or any requests requiring payment of a claim, using good judgment and your knowledge of the company's products and/or services.

To help you perform your duties, you use a computer system to obtain and/or transmit information.

Key Responsibilities:

• Analyze health/dental insurance claims (Regional and National Groups) for both special groups and requests for adjustments to determine if the expenses submitted are eligible for the insurance benefits and, if necessary, deny claims;
• Obtain all required information prior to payment of claims from special groups/requests. Research and communicate in writing or by phone with the client, as needed, to process the claim fully when received;
• Enter the data in the computerized claims processing system;

• Conduct necessary research to accurately respond to queries using various systems, tools, and resources available;
• Use the computer system when responding to various requests in order to accept or deny claims in accordance with the contract and/or eligibility of the insured and by applying company policies and procedures;
• Demonstrate excellent analytical and judgment skills in connection with the contractual requirements of certain groups, which involves researching websites, including government websites;
• Process health/dental claims for new groups being monitored for a predetermined period in order to analyze all denials and ensure they are in compliance with the contracts. The analysis must be carried out using the contracts and/or Master App as well as all available tools. Denials that are not in compliance with the contract are submitted for validation;
• Perform all calculations required to pay a claim when the computer system cannot calculate them automatically;
• Support continuous improvement by seeking and identifying opportunities for improvement to processes and tools from a members' perspective as well as from personal experiences, sharing ideas with team leaders and others as appropriate;

• Constantly update knowledge of processes and procedures;

• Work closely with Specialists, Sales and Team Leaders and Managers when required;

• Perform any other similar or general tasks as required by the position or as requested by the supervisor.

Required Qualifications:

  • Post-secondary education
  • Work experience in an office and/or general customer service environment
  • Data entry experience is considered an asset
  • Strong organizational skills
  • Action oriented
  • Works efficiently under pressure
  • Makes decisions in a timely manner
  • Attentive and active listener
  • Always acts with customers in mind
  • Enjoys working hard and full of energy even during challenges
  • Seen as a team player and is collaborative and cooperative
  • Bilingual

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] .

Competition Number: R-253963
Company Website: http://www.medavie.ca

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About Medavie

About Medavie

Full careers. Full lives.
Medavie is a national health solutions partner and innovative leader in benefits management, health management, and healthcare delivery. Backed by our team of over 8,200 professionals, we exist to improve the wellbeing of Canadians so every life can be lived to the fullest.

We’re one of Canada's Most Admired Corporate Cultures, one of Canada's Top 100 Employers, and certified Rainbow Registered as an organization that champions diversity, equity and inclusion. We foster a culture of caring where people are celebrated beyond their roles and valued for who they are and what they contribute.

Join us to be there for Canadians — and achieve your full potential in a supportive and dynamic environment.

Work environment
At Medavie, you’ll find more than just a job — you’ll find a pathway to a full and rewarding career. As an organization and employer, we are:

  • People first
    We care about our employees and everyone we serve. By championing a people-first culture, we empower our team to make a profound impact on the lives we touch.
  • Wellbeing focused
    By prioritizing health and wellbeing in all aspects of our work, we help our employees make a difference in the lives of Canadians while leading full lives themselves.
  • Visionary
    Our innovative spirit drives us to lead advancements in health and wellness, delivering meaningful results while also fostering a forward-thinking work environment.

Community involvement
As a not-for-profit organization, we invest in our employees, operations, and the communities where we live and work. The Medavie Foundation is an extension of our commitment to deliver community-centered health care and is focused on improving access to equitable, culturally-aligned care in the areas of healthy living, youth mental health, and post-traumatic stress.

An award-winning culture
We’re one of Canada's Most Admired Corporate Cultures, one of Canada's Top 100 Employers, and certified Rainbow Registered as an organization that champions diversity, equity and inclusion.

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