Key duties and responsibilities
Claims Adjudication & Relationship Management
- Analyze medical, financial and contractual information in order to make timely and accurate decisions on claims
- Provide value-added claims adjudication expertise on Life, CI, DI, LTD and accidental death claims
- Provide advice to clients concerning contentious claims, claim practices, policy rescissions and benefit/policy interpretation
- Establish target response time and ensure that objectives are met
- Support other business units with timely communication of issues, escalations or points of interest
- Remain current on industry practices, emerging trends and developments
- Participate in the development of Claims management procedures and guidelines within SCOR Global Life Canada
- Provide advice to underwriting management concerning claims experience in the industry pertaining to underwriting matters, pricing, policy exclusions and insurance applications
Audits & Training
- Assist in the performance of claims audits for all lines of business
- Participate in client meetings and provide training either virtually or in-person; travel to client offices may be required
- Contribute to the development of training programs for clients
Other:
- Review and establishment of claim referral guidelines
- Provide input into decisions regarding new tools, processes and technology upgrades
- Project management and data analysis
- Respond to special requests from clients and resolve complex issues
- Support marketing efforts of the Business Development team by maintaining positive relationships with clients
- Enhance and maintain internal litigated claim management and record keeping practices to minimize risk exposure, contain costs and realize optimal resolutions
- Represent the company at industry events as an attendee and/or presenter
- Participation on industry committees
Required experience & competencies:
Experience:
|
|
More Information
- Experience Level Junior
- Total Years Experience 0-5
