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Claims Review Specialist

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Canada Life

2mo ago

  • Job
    Full-time
    Entry, Junior, Mid & Senior Level
  • Legal
    Healthcare
  • London

AI generated summary

  • You need a post-secondary degree/diploma or equivalent experience, strong communication skills, technical proficiency, and an understanding of health/dental claims processes.
  • You will review claims, assess documentation, handle referrals, communicate with members/providers, manage claim documents, and identify fraud risk for further investigation.

Requirements

  • Post-secondary degree/diploma or equivalent work experience
  • Education or work experience in an audit/quality/fraud discipline considered an asset
  • Experience within a paramedical or other clinic setting considered an asset
  • Excellent communication skills, both written and oral
  • Ability to manage multiple demands with tight deadlines is necessary.
  • Strong technical skills including Outlook, Excel, Teams
  • Ability to work independently and collaboratively at all levels
  • Understanding of Health and/or Dental Claims processes and business knowledge would be an asset.
  • Reliability Status security clearance - this is a personnel security status that is required before an employee can gain access to Protected B information, assets or work sites as outlined by the Government of Canada website

Responsibilities

  • Conduct claims reviews, including assessment of documentation for preselected claims
  • Handle referrals from other business units, to investigate concerns identified and follow up on non-responses
  • Prepare communications to be sent to members and providers seeking confirmation or clarification of claim information
  • Receive, file and action claim review documentation from providers and members
  • Identify fraud risk factors of claims reviewed and escalate or refer for further investigation if appropriate

FAQs

What is the role of a Claims Review Specialist?

The Claims Review Specialist is responsible for conducting claim audits, handling escalations, preparing communications to members and providers, and identifying fraud risk factors related to claims.

What qualifications are required for this position?

A post-secondary degree/diploma or equivalent work experience is required, and experience in an audit/quality/fraud discipline or within a paramedical clinic setting is considered an asset.

Are there opportunities for career advancement?

Yes, Canada Life offers career opportunities, and you can excel and grow within the organization.

How many days in the office are required for this position?

This is a hybrid position that requires three days in the office.

What locations are available for this position?

The position can be located in London or Winnipeg.

What type of communication skills are necessary for this role?

Excellent communication skills, both written and oral, are necessary for preparing communications and interacting with members and providers.

What software skills are required for this position?

Strong technical skills in Outlook, Excel, and Teams are required.

Is there a salary range for this position?

Yes, the base salary for this position ranges from $38,300 to $54,700 annually.

What kind of security clearance is needed?

Reliability Status security clearance is required to access Protected B information, assets, or work sites.

How will my application be processed?

Applications will be reviewed on a rolling basis, and the position will be open for a minimum of 5 business days from the date of posting.

Does Canada Life promote diversity and inclusion?

Yes, Canada Life is committed to providing an inclusive environment where all employees and customers feel valued and respected.

What should I do if I need an accommodation during the application process?

You can request a reasonable accommodation by contacting talentacquisitioncanada@canadalife.com during the application process.

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Canada Life

Helping Canadians improve their financial, physical and mental well-being.

Finance
Industry
10,001+
Employees
1847
Founded Year

Mission & Purpose

At Canada Life, we’re focused on improving the financial, physical and mental well-being of Canadians. Whether handling policy claims, help growing and protecting clients’ retirement and investment savings, providing workplace mental health support for all employers or helping build stronger communities by investing in community projects, we are committed to putting the customer first in all that we do. That trust is built on the dedication, skill and energy of our employees and advisors and their commitment to our customers and to our communities. Canada Life is a subsidiary of Great-West Lifeco Inc. and is a member of the Power Corporation group of companies.

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