Life Claims Examiner I

Company: CLIC
Department: Life Claims
Employment Type: Regular Full-Time
Work Model: Hybrid (2 days in office)
Language: English is required, French is an asset.
Additional Information: This/these role(s) is/are currently vacant

The Opportunity:

We are a leading Canadian financial services co-operative committed to being a catalyst for a sustainable and resilient society and our team is essential to deliver on this strategy. That’s why we prioritize our people, to ensure we provide a strong culture and development opportunities which enables our team to thrive and to live our purpose. The best part is that you will work with people that care passionately about you, our clients and our communities.

Our Group Benefits team is a leader in our target markets through service excellence and innovative technology and products. Influenced by our co-operative values, our team of experts work collaboratively with clients to deliver solutions that meet their business needs.

The Life Claims Examiner I verifies and analyzes documentation for all claims including contestable, contentious and complex claim documentation, specializing in one of two lines of business (LOB) either Individual Life, or Group Life for numerous products. Products will include life, critical illness, disability waiver, living assistance and direct marketed products. The role must understand policies and regulatory provisions as it applies to each product, respond to inquiries and complaints on claims and act as a claims resource on special projects.

How you will create impact:

• Confirm coverage and analyze claim by determining type of claim, managing investigation process, involving Underwriting, medical director or legal if required and reviewing and interpreting all claims documentation and information
• Obtain required claim documentation and complete the required claim investigation within service standards.
• Provide final claim decision including payment, denial, rescission of coverage/policy, and advance payments and prepare detailed correspondence supporting decision
• Investigate material misrepresentation, fraudulent claims and changes of insurability and determine proper course of action moving forward.
• Effectively respond to client inquiries and educate the field partners on insurance legislation and claims practices both verbally and in writing.
• Accurately handle phone calls, correspondence and complaints from claimants, beneficiaries, family members, legal counsel, physicians, employers, TPA's and all field partners.
• Act as a resource for contact interpretation and maintain strong working relationships with advisors, TPA's (Third Party Administrators), contact center, Credit Unions and others as required and other internal departments as needed.
• Act as a resource to team and assist in the training of Life Claims Assessor roles.
• Participate in projects relating to new products, processes and system enhancements.
• Attend Legal examination for discovery as requested by plaintiff or Co-operators legal counsel.
• Attend industry workshops and education session for continued learning
• Maintain industry contact and keep informed on changing environment.

To join our team:

• You have 1-2 years of relevant experience in specific field/industry.
• You have medical terminology or previous experience/education in medical field
• You have completed LOMA courses.
• You will need to complete the Associate Life & health Claims(ALHC) designation acquired within 2 years in the role.
• You have detailed understanding of multiple administration systems ( Ex: CAPP, Ingenium, BenefitsNow, Compass, Horizon, OnBase, LifePages, ECM, Xybernet, Benefit Group life claims system, CATS)
• Bilingual verbal and written communication skills in English and French would be considered an asset.

How you will succeed:

• You influence change and are committed to continuous improvement, in order to exceed client expectations.
• You leverage critical thinking skills to identify problems and proactively propose solutions.
• Your strong communication skills allow you to clearly convey messages.
• You’re an effective team player who shares knowledge to support our peers.

What you need to know:

• You will be subject to a Background check as a condition of employment, in the event you are the successful candidate.

What’s in it for you?

• Training and development opportunities to grow your career.
• Flexible work options and paid time off to support your personal and family needs.
• A holistic approach to your well-being, with physical and mental health programs and a supportive workplace culture.
• Paid volunteer days to give back to your community.
• In addition to our competitive salary and incentive programs, eligible employees also benefit from a comprehensive total rewards package including group retirement savings plans, pension and benefits (e.g., health and wellness, dental, disability and life coverage), mental health support and an employee assistance program.

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Expected salary/hourly range $50,280 to $83,800 CAD​

The salary amount for the successful candidate is determined by Co-operators in its discretion and will vary depending on several criteria including but not limited to: local market conditions, geography and relevant job-related factors such as knowledge, skills, qualification, experience and education.

Employees may also have the opportunity to participate in incentive programs and earn additional compensation tied to individual and/or business performance, or other business metrics.

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