Industrielle Alliance, Insurance and Financial Services

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Position Details - Bilingual Claims Examiner

Company:Industrial Alliance Insurance and Financial Services Inc.
Category:Claims
Position ID:J0413-0882
Job Type:Regular Full Time

Company Overview:

A step forward in your career!

A career with Industrial Alliance Insurance and Financial Services means working in an enriching environment that encourages personal and professional development.

We offer a workplace where everyone plays an essential role in the success of our Company and where individual efforts are acknowledged.

Our tradition of excellence is built on a strong team spirit, a challenging environment, and continuous development.

Achieve success.
Join Industrial Alliance!

Video:
Build your career at Industrial Alliance

Description:

1. Claims Management
With assistance from a Claims Specialist I or II:
• Determine claims eligibility on application for benefits under various Creditor products.
• Products include disability, life and critical illness benefits.
• Create case management strategies for those accepted claims and carry out the planning and implementation of these strategies to effectively manage claims through recovery or closure, in the shortest time possible.
• Manage claims through decision-making in accordance with the Certificate of Insurance provisions that can differ from certificate to certificate, and explain/clarify provisions to claimants, financial institutions, and occasionally, car dealerships. It is
also important to keep abreast of current legal issues and implications to ensure that IA is not exposed to punitive damage suits.
• Initial and ongoing case management of claims by compiling and evaluating medical and other information provided by the claimant, claimant's employer and medical practitioners, keeping abreast of current and new medical processes.
• Consults with in-house Medical Directors on medical information.
• Written communication consists of 75% standard letters with some modification and 25% customized letters.
• Discuss and present difficult or complex claims before peers and management.

2. Financial Management
• Ensure that the claims process maintains correct reserve setting, through the accuracy of data entry to the mainframe and creditor system.
• Negotiate with the financial institutions/claimants in the case of an overpayment to ensure that IA receives a full refund. This can involve setting up a repayment schedule.

3. Client Relations
• Develop positive and effective relationships with the claimant base, financial institutions, and appropriate, car dealerships.
• Provide appropriate and timely communication, while maintaining the confidentiality required with claimants, employers, attending physicians, financial institutions, other insurers, representatives, medical professionals, other departments within IA, and where appropriate, car dealerships.
• Assist in the investigation and handling of claims appeals and complaints at level one nature.
• Interact on a daily basis with disability claimants suffering both physical and mental illnesses in an empathetic but firm manner according to the Certificate of Insurance provisions and in keeping with the ICA Statement of Principles.  

4. Process Integrity
• Maintain established claims management practices, be cognizant of claims practices and suggest process improvements when noted, and achieve service standards.
• Ensure file documentation is precise, accurate and objective to meet legal standards.
• Ensure computer records are correct and cheques are issued on a timely basis.
• Utilize internal resources (medical and legal) appropriately and within time standards.

Qualifications:

Ideally, you have:

You have a university degree, enjoy making your own decisions; working independently; and have excellent written and verbal communication skills in both French and English. An interest in medical sciences and some experience in the insurance industry would be an asset.

Education and Experience
• Minimum completion of Post Secondary or Community College Diploma or an Undergraduate university degree in Science or Business Administration an asset
• Minimum years related industry experience.
OR
• High school graduation diploma plus 1 year post secondary education
• Industry related experience of 6 to 8 years, of which a minimum of 2 years in claims adjudication or claims assistant experience, with an in-depth knowledge of medical terminology.
Designations
• Completion of LOMA Level 1, CSI. ICA 1 & 3 or working on these courses an asset. Willing to complete Associate ALHC designation.

Skills

Basic Skills
• Proven excellence in communication (verbal /written).
• Critical thinking analysis and Decision making ability.
• Superior organizational skills and ability to multi-task.  
• Proven dedication to customer service.
• Demonstrated initiative and drive.
• Strong sense of urgency.  
• Good conflict resolution, negotiation and problem solving skills.

Computer, Systems and Technology Knowledge
• Basic PC Skills, Mainframe application experience.
• Microsoft Office (Word, Excel, Outlook).
• Familiar with the Internet and maneuvering within a Web based application.

Skills:

Please answer all of the following questions before applying
* Question numbers in red and with an asterisk indicate mandatory questions (answer is required).

*1. 
 
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