Health and Dental Claims Examiner

Health and Dental Claims Examiner  $45,000 – $50,000

Comma Recruitment require a claims examiner to process claims for Extended Health and Dental benefits using the technical knowledge obtained from the policies, procedural manuals, industry and government communications. Reporting to the Claims Manager you must be able to work independently with little supervision, possess the ability to distinguish priorities and adapt well to change. The individual must work well under pressure, maintain production requirements and must be willing to work overtime as required. QUALIFICATIONS Post Secondary diploma or recognized business experience in a related field A minimum of two year’s experience adjudicating health and dental claims Knowledge of and hands-on experience using Windows and Microsoft Office technology Excellent keyboarding skills. Superior customer service skills including an excellent telephone manner. Ability to work quickly and accurately under pressure Must be able to meet departmental standards for claims processing, after a pre-determined training period. Knowledge of and aptitude for calculating benefit payments. Possess organizational skills, oral and written English/French Bilingual is an asset though not a requirement   DUTIES AND RESPONSIBILITIES Some of the duties of this position include the following: Processes Extended Health & Dental benefits through the use of an automated claims payment system. Ensures all claims are processed in date order, by automatically assisting other examiners in the processing of their assigned plan(s) when their own client base is in good order. Maintains daily production requirements to a minimum as determined by the Team Leader. Liaises in a professional manner with insurance agencies, doctors, trustees, members, management, lawyers, etc., ensuring that only allowable information is released to recognized recipients and that all information is released in writing. Keeps abreast of industry and government requirements. Operates automated claims payment system and performs manual calculations as required.

 

Please forward resume to [email protected]

Auto Claims Adjuster – Technical Specialist – Toronto

Auto Claims Adjuster – Technical Specialist

Comma Recruitment require a Senior Technical Specialist, Auto PD and Cargo Claims, responsible for providing efficient and prompt investigation, evaluation, negotiation, and settlement of large and/or complex claims in accordance with corporate guidelines and best practices. The technical specialist is a key technical expert within the claim unit and can support their teams from a technical perspective.

·         Investigate, appraise/scope, confirm coverage, negotiate settlement and recovery, and conduct reporting and documentation of substantial and complex claims in accordance with established guidelines.

·         Ensure the accurate and efficient payment of claims.

·         Prepare summaries and files for litigation, mediation/arbitration, and multidisciplinary assessments.

·         Assist Manager with preparing/completing monthly statistical reports.

·         Adhere to service standards by communicating effectively with all parties involved.

·         Develop relationships with other departments such as underwriting in order to meet business goals.

·         Understand and apply best business practices towards compliance, internal control and operational risk controls in accordance to national standards and regulatory standards and policies.

·         Mentor and coach less experienced claims and support staff.

·         Work collaboratively with Supervisors and/or Managers on special projects and assignments requiring advanced technical skills and knowledge when required.

·         Other duties as assigned.

 

Requirements

·         Post-secondary education and / or equivalent on the job experience

·         Minimum 5+ years Claims adjusting experience examining large and/or complex claims.

·         Working knowledge of the company principles and practices related to claims settlement, policy wordings, insurance contracts, fraud investigations, serious losses and coverage questions.

·         Ability to work within and adapt to PC oriented environments, including familiarity with e-mail and Internet skills. Advanced knowledge of Microsoft Office.

·         Completion of the CIP/FCIP designation or working towards

 Please forward resume to [email protected]

Life and Critical Illness Underwriter

Life and Critical Illness Underwriter

Comma Recruitment are looking for two Life and Critical Illness Underwriters, reporting to the Director of Underwriting you will be responsible for sound and accurate assessment of medical and financial information to minimize risk exposure for life & critical illness business.

KEY RESPONSIBILITIES:

• Underwrite new business using sound underwriting guidelines for morbidity and mortality within service standards in accordance with company guidelines
• Work within assigned authority along with reinsurance guidelines
• Document underwriting methodology and processes
• Communicate with field associates in answering questions, and/or advising unfavorable decisions
• Support and provide feedback to the Director in the development of new guidelines and finding efficiencies

 

REQUIREMENTS/ EXPERIENCE:

• 1+ years experience in a similar role  at intermediate level or 3+ for Senior position
• Knowledge of medical/legal terminology is required
• Insurance background & knowledge a great asset
• Community college diploma / university degree or relevant experience
•  Working towards or nearing completion of LOMA, FLMI or  ALU designations
• Bilingual an asset although not required
• Ability to think logically and analytically
• Sound judgment and decision making skills
• High accuracy level and attention to detail
• Strong Team Player and self-starter
• Ability to make sound decisions
• Strong time management and organizational skills
• Excellent verbal and written communication skills
• Ability to multi-task in a fast-paced environment
• Eagerness to learn and be self-motivated to develop a career path in Underwriting
• Must be computer literate, strong computer skills within a Windows environment

Please forward resume to [email protected]

Disability Claims Adjuster

Disability Claims Case Manager / Adjuster

Comma Recruitment require a Disability Claims Adjudicator – Adjudicate and manage short and long term disability claims. Provide efficient and timely service to all key stakeholders.

Location: Toronto West and Mississauga

Main Accountabilities:

• Review claim forms, medical reports, investigation reports, contract provisions etc. and determine eligibility of claim
• Record inbound/outbound communication
• Provide written and verbal communication to claimants, clients, administrators, doctors, lawyers, other insurers, etc: re: claim inquiries and outcome
• Review claims with Medical Director and Legal Department as required
• Assess waiver of premium eligibility
• Develop and implement return to work strategies
• Interact and develop good relationship with several stakeholders to facilitate best results

Competencies:

• Min 2 – 5 years group claims experience
• Experience adjusting STD/LTD benefit claims
• Excellent written and verbal communication skills
• Bilingualism in French/English is an advantage though not required
• Excellent customer service
• Intermediate skills with Word and Excel
• Ability to multitask in a fast paced, performance driven environment
• Strong planning and organizing skills, with strong attention to detail
• Analytical thinker with proven problem solving skills
• Ability to adapt quickly and comfortably to change
• Good interpersonal skills
• Professional telephone etiquette
• Demonstrates a positive attitude and a desire to succeed
• Strong team player

Please forward resume to [email protected]

Director, Corporate Underwriting – Property

Director, Corporate Underwriting – Property         $100,000 – $120,000

The Director of Property in Corporate Underwriting will proactively look for ways to drive the profitable growth for property business.

The incumbent is responsible for the development of superior property products, technical underwriting guidance and working with Actuarial on sophisticated pricing tools.  In addition, the incumbent is responsible to manage the performance of the property lines of business as well as manage a team of strong technical underwriting experts.

Responsibilities:

Develop superior property products.

• Define the product strategy and roadmap in conjunction with other stakeholders in our Product Factory.
• Drive product strategies to improve line of business results aligned with organizational strategic imperatives.
• Evaluate and support prioritization of opportunities for product enhancements.
• Develop enhances and innovative insurance products supporting our customer centric strategy, and support marketing material development.

Create property underwriting frameworks, guidelines and policies to ensure profitable underwriting results across all regions.

• Drive underwriting strategies to improve line of business results aligned with organizational strategic imperatives.
• Develop underwriting guidelines that ensure consistent application of the framework, including systems enhancements.
• Working in collaboration with regional UW teams, ensure that frameworks are well understood and being applied consistently across all regions.

Collaboratively sets sophisticated property technical pricing guidelines with actuarial, aligned with profitability targets.

• Drive segmentation by identifying key rating variables and developing associated pricing factors.
• Ensure technical prices are calibrated with company’s profitability targets.
• Work closely with regions and actuarial pricing to ensure products are appropriately priced and the business is generating expected profitability targets.

 

Participate with others in the Corp Underwriting in the development of regional underwriting property skills.

• Participate in identification of development needs and training required.
• Develop and delivery of technical training aligned with underwriting training programs.
• Brief and train the regional management and distribution at selected intervals.

 

Evaluate property underwriting performance and develop strategies to improve profitable growth performance.

• Accountability to ensure that profitability targets are met by monitoring ongoing line of business and product profitability across all regions.
• Monitor portfolio performance through analysis of key performance indicators (growth, combined ratios, coaching scores, etc.)
• Drive the development of audit questions and reports to assure oversight of underwriting practices.
• Participate in audits and review audit results.
• Accountability for guiding the development and delivery of new strategies to ensure future profitability and to course correct, if required.

Drive quality and efficiency of Corporate Underwriting property resources.

• Plan departmental resourcing needs, plan for growth and ensure that attendance and vacation requests are managed for the team.
• Coach, mentor and direct staff.
• Evaluate staff performance in relation to standards and progress toward achieving individual and organizational objectives.

Other duties as assigned.

Qualifications

Post-secondary education or equivalent business experience.

Excellent depth of underwriting knowledge on specific product area (e.g. Property, Casualty, or Liability).

Completion of or working towards CIP/FCIP designation.

7+ years of progressively more senior UW experience.

3+ years of experience supervising staff.

Working knowledge of the MS Office suite of products (Word, Excel, Outlook), and the Internet.

Fluently bilingual (English / French) is a definite asset

 

Please forward resume to [email protected]

« Previous Page — Next Page »