specialist claims examiner

Our vision for the future is based on the idea that transforming financial lives starts by giving our people the freedom to transform their own. We have a flexible work environment, and fluid career paths. We not only encourage but celebrate internal mobility. We also recognize the importance of purpose, well-being, and work-life balance. Within Empower and our communities, we work hard to create a welcoming and inclusive environment, and our associates dedicate thousands of hours to volunteering for causes that matter most to them.

Chart your own path and grow your career while helping more customers achieve financial freedom. Empower Yourself.

Great West Global is growing their global presence and support. Our innovative and growing company is looking to fill the role of Operations Manager. Successful candidates will learn more about the specific opportunity during the interview process.

About Candalife: We Canada Life is an insurance and financial services company with its headquarters in Winnipeg, Manitoba. We provide a wide range of insurance and wealth management products for individuals, families, and business owners from coast to coast. Canada Life is focused on improving the financial, physical and mental well-being of Canadians and believes in good corporate governance & we do offer health and dental insurance, benefit and savings plans, charitable giving, and workplace mental health resources. Please log on to our website to know more about us.

We offer competitive salary and bonus program that rewards your performance in achieving individual and team objectives. As well, an employee recognition program rewards exceptional performance. In addition to salary, annual bonus, and employee recognition programs, you are entitled to a comprehensive benefit package, with options to personalize the benefits package to meet the needs of you and your family.

As a member of the Health and Dental Operations team, a Claims Examiner reviews, investigates and adjudicates Canadian health and dental claims in accordance with group policy contracts. Strong focus on ensuring accurate payment decisions according to adjudication guidelines and processing a high-volume of claims in an efficient manner. Also works in collaboration with other areas of Canada Life to ensure timely assessment of claims. A Group Claims Examiner represents the company through telephone calls to providers as well as written correspondence to plan members and service providers to ensure complete details are received for claims adjudication.

Essential Functions

• Review, investigate, and adjudicate Canadian Health and Dental claims in accordance with Group policy, contract, and administrative guideline.
• Assess claims to ensure accuracy, completeness, and compliance with established adjudication rules.
• Conduct phone calls to plan members and health/dental service providers to obtain or clarify claim information.
• Make consistent, well-supported claim decisions based on policy and procedural guidelines.
• Demonstrate the values of Customer View; Integrity; Partnership; and Communities.
• Contribute to achieving operational objectives including time service, quality, productivity, and relative performance.
• Work effectively within a team environment to support shared goals and provide exceptional service.
  
  

Qualifications & Competencies

• Minimum keyboarding speed of 40-50 wpm and ability to manage high volumes of work with a high level of accuracy.
• Strong analytical and critical-thinking skills.
• Well-developed organizational skills with the ability to prioritize tasks in a fast-paced environment.
• Excellent written and verbal communication skills.
• Ability to work independently and collaboratively within a team environment.
• Reliable, punctual, and committed to high standards of work quality.
• Proven ability to deliver excellent customer service.
• Business-related post-secondary education and/or equivalent combination of education and experience.
• Ability to excel in a Purpose/Vision-driven environment.
• Normal Office Working Conditions: this job operates in a professional office environment and routinely uses standard office equipment.
  
  

This job description is not intended to be an exhaustive list of all duties, responsibilities and qualifications of the job. The employer has the right to revise this job description at any time. You will be evaluated in part based on your performance of the responsibilities and/or tasks listed in this job description. You may be required perform other duties that are not included on this job description. The job description is not a contract for employment, and either you or the employer may terminate employment at any time, for any reason, as per terms and conditions of your employment contract.

We are an equal opportunity employer with a commitment to diversity. All individuals, regardless of personal characteristics, are encouraged to apply. All qualified applicants will receive consideration for employment without regard to age, race, color, national origin, ancestry, sex, sexual orientation, gender, gender identity, gender expression, marital status, pregnancy, religion, physical or mental disability, military or veteran status, genetic information, or any other status protected by applicable state or local law.

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