You process claim files according to Company policies and procedures. This involves reviewing claims, recommending payment or denial, or requesting additional information. You process approved payments and/or denials for travellers and providers and set up payment requests from other insurers. You also are a critical part of our Medical Assistance Team by answering calls and coordinating the immediate medical needs of our travellers, with the support of Case Managers and TuGo Physicians.
Specifically You Will
Process claims according to Company policies and procedures. This involves reviewing claims for completeness and compliance with policy coverage and recommending acceptance or denial of claim and expenses.
If claim requires additional supporting documentation to confirm payability, request and review medical history, medical records, itemized bill, etc. following established SOPs.
Process payments and/or denials to travellers and/or providers.
Set up requests for payment from provincial medical plans, extended health plans and any other insurers.
Assist Customer Service Team by providing claim information to help resolve travellers’ phone and email inquiries.
Perform duties of a Medical Assistance Case Coordinator as needed and as directed by your supervisor.
Achieve performance targets.
Collaborate and communicate effectively with team members and all other teams.
Responsively and effectively handle issues.
Look for ways to improve customer experience.
Promote and model TuGo culture, values, and brand promise.
Continuously build professional and technical expertise.
Other duties as required.
What You'll Bring
Degree or Diploma in a business-related discipline
Successful completion of Level 1 Insurance Adjuster’s Licence or Level 1 General Insurance Licence (within first year of employment)
Level 2 Insurance Adjuster’s L icen c e or Level 2 General Insurance Licen c e is an asset
Ability to learn and apply knowledge of policy wordings to accurately process claims
Strong analytical , problem solving and decision-making skills, detail-oriented and well organized
Excellent communication/customer service skills, particularly by phone and email
Excellent w ritten and verbal skills
F luency in an additional language – preferably French, Spanish, Mandarin, or Cantonese – is an asset
Previous experience assessing claims is a n asset
Experience in customer service is an asset
Ability to multi-task
Strong interpersonal, and conflict resolution skills
Knowledge of medical terminology is an asset
Criminal record check is a requirement of the position as required by insurance councils for licensing
Once fully trained, work schedule will include some non-business hour shifts (weekend and evening shifts)
Strong team player and positive contributor
Proficient in MS Office Suite and able to learn applications quickly
Able to consistently live our values of valued, effective and trusted
A strong customer experience focus
A passion for continuous learning and professional achievement
Salary range: $50,000 - $66,000
Seniority level
Entry level
Employment type
Full-time
Job function
Finance and Sales
Industries
Insurance
Referrals increase your chances of interviewing at TuGo by 2x