Claims Assessor – Global Excel

Title of the Job: Claims Assessor

Location: Windsor, ON

Job Description: Job DescriptionAs a Non-Medical Claims Assessor, you will evaluate and enforce claim benefits and limitations based on a comprehensive understanding of the applicable policy wording. The claims assessor is responsible for qualifying a claim/bill for payment and reviewed for customer service and may require direct client contact. The assessors are responsible to contribute to cost containment efforts by validating bills for services rendered, authenticity and reasonable and customary charges.What does your typical day look like?

• Review applicable policy wording to validate claim coverage;
• Review bills for rendered services, coding and reasonable & customary charges ensuring clean bill components are present and are directed to the appropriate internal financial process;
• Claims are reviewed with precision for compliance with expressed client directives (as applicable)
• Establish presence of claim requirements as per policy wording (i.e.: proof of payment and authenticity of bills/claims)
• Research and confirm global claim influences (i.e. travel advisories)
• Contact client to request missing claim components as required for adjudication;
• Clarify and explain denials if required;
• Provide notice of claim decision via email, phone or formal letter;
• Ensure creation of appropriate follow up workflows;
• Confirm and adjust (if required) claim entries.

Skills and Requirements:

• College diploma or equivalent;
• Knowledge of insurance product benefits and limitations;
• Ability to efficiently and thoroughly read a policy wording;
• Comprehension of healthcare systems and billing practices;
• One to two years of experience in a customer service-related position;
• Strong decision-making skills and attention to detail;
• Excellent verbal and written communication;
• Good organizational skill and ability to prioritize;
• Proficiency in the Microsoft suite products;
• Clear and effective communication in English or French (written and verbal); other languages such as Spanish are an asset;
• Available to work daytime schedule. Evenings and weekends may be requested with appropriate notice.

When you apply:If you require assistance or accommodation during our recruitment process, please notify Human Resources so that we can review and consider how we may be able to assist you based on your individual needs.Note: Only applicants selected for an interview will be contacted.We offer youAt Global Excel we believe in investing in our employees!

• Competitive wages;
• Bilingual language premium when applicable;
• Group health /dental benefits, RRSP matching;
• Paid training and the opportunity for professional development;
• Growth and advancement opportunities;
• Work life balance;
• Focus on health and wellness initiatives with an excellent EAP program;
• Employee engagement programs that focus on fitness, food and fun

Company Name: Global Excel

Salary:

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