Claims Examiner

Claims Examiner Canada

The Claims Examiner is responsible for evaluating and processing claims on primarily one business/product line by performing all functions required to determine if the claim is or is not payable/deferred/or cancelled. This position provides correspondence to internal/external customers.

In the Role

• Evaluate claims against eligibility requirements, provisions and applicable processes.
• Enter data into appropriate processing systems, including correspondence with internal and external customers.
• Research additional information to support claim processing. Perform benefit calculations. Conduct claim investigation.
• Occasional special projects.
• Participate in departmental meetings and training activities.
• Make and receive English and French phone calls.
• Process incoming and outgoing mail.
• Other duties as assigned.

Requirements

• High School or GED Required
• 1 year of general work experience, 6 months or more claims experience preferred
• Basic math skills, familiar with PC Environment
• Sound judgment, verbal and written communication skills
• Manage positive customer relationships
• Ability to evaluate claims against eligibility requirements
• Fluent in speaking and writing French