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About The Job
We’re changing the way people think about customer service, and we need your help!
We’re looking for an Claims Administrator (French/English Bilingual) to follow-up with insurance plan members to obtain documentation, ensure forms are complete and respond to any questions around the claims process. The ideal candidate will also ensure forms are accurately set up within the system in accordance with contracts and any other required special information.
As Claims Administrator (French/English Bilingual), You Will…
- Provide email and inbound/outbound phone support
- Review systems, claim documents and contracts to ensure eligibility requirements are met for coverage
- Communicate with the plan sponsor if discrepancies or information is missing
- Be responsible for timely outreach calls to collect missing or unclear information
- Decline claims if eligibility requirements are not satisfied, and send out declination letters to plan sponsors and plan members accordingly
- Escalate issues and claims to Senior Advisor if eligibility requirements are not satisfied (or route to Management, as appropriate)
- Provide follow-ups and ensure plan members are handled accordingly
- Ensure proper security procedures are followed on all client interactions
- Provide proper information to customers by maintaining thorough knowledge of internal systems
- Learn and retain a thorough working knowledge of all existing and new products
- Achieve assigned Key Performance Indicators (e.g. Call Handle Time, Email Response Time, Quality, Customer Satisfaction Indices)
- Attend team meetings and additional training sessions as scheduled
- Performs other duties as assigned
Requirements
As Claims Administrator (French/English Bilingual), You Have…
- High-School Diploma or equivalent (required)
- Bilingualism in French and English, written and oral (required)
- Previous work experience in the disability insurance sector (preferred)
- 1+ year of experience in customer service or an administrative position
- Experience with policy analysis (preferred)
- Basic knowledge of medical terminology (preferred)
- Experience working in the insurance industry (asset)
- Superior customer service, analytical and decision-making skills
- Advanced typing and data entry skills
- An understanding of complex instructions and basic contractual language
- Strong verbal and written communication skills, including spelling and grammar
- Intermediate to advanced technology skills using Microsoft Office (Word, Excel, PPT, etc.)
- The ability to multitask and self-manage your work day
- The ability to work both independently and in a team setting within a fast-paced environment
- Exceptional organizational, time management and prioritization skills
- The ability to meet and sustain productivity and turnaround time expectations
- Superior attention to detail with an eye for accuracy
- The ability to remain calm under pressure and make smart, quick decisions
- The ability to easily adapt to changing technology
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