Bilingual – Senior Claims Adjuster

BILINGUAL-  SENIOR CLAIMS ADJUSTER

Comma Recruitment are looking for a Senior, Bilingual Claims Adjuster:

• Adjudicate contested and complex accident, life, critical illness, cancer and sickness disability claims.
• Adjudicate suspicious and fraudulent claims and refer files for special investigation if required
• Approve, deny or enquire further information from claimants, doctors or hospital to assess claimant’s eligibility for benefits.
• Interpret and administer policy provisions including, but not limited to eligibility, definition of total disability, and pre-existing investigations.
• Review and make decisions for policy rescission, after discussion with underwriting.
• Request independent investigation on claimants such as activities check/IME/peer-to-peer assessment.
• Consult with other departments (Legal, Medical Consultant, Underwriting, etc) as required and conduct investigations.
• Discuss and explain benefit payments to claimants. Document claim file actions and telephone conversations appropriately. Follow up on claims and send timely follow-up reminders.
• Review and approve adjusters’ files over their approval limits.
• Provide ongoing training and coaching to adjusters and new hires.
• Handle complaints – log, review, communicate with all parties involved, and provides response to complainants and/or Department of Insurance or other consumers agencies in accordance with Company compliance.
• Required to meet or exceed departmental service, quality and production objectives.

QUALIFICATIONS REQUIRED

• Minimum high school education or college diploma
• Minimum 5 years of claims adjudication experience
• Bilingual – English and French written and verbal communication skills
• Mathematical skills – aptitude for figures
• Insurance courses such as LOMA and HIAA
• Ability to make good decisions and use sound judgment
• Strong knowledge of medical terminology

Please forward resume to [email protected]