Position:Bilingual Claims AdjudicatorCategory:



East York

Branch Name:MississaugaDress Code:
Branch Phone:(905) 5688828Job ID:4943
Pay Info:Order Type:DH

As a Member of the Claims Service team this position is responsible for the assessment and payment of death claims while adhering to all regulatory and policy contract provisions.

• Responsible for the adjudication of death claims: collects and reviews all relevant information to determine legitimacy, eligibility and benefit amount payable
• Performs all required calculations and ensures all activities are in compliance with legal and TPA client’s standards
• Communicates verbal and written information as appropriate to those with a need to know. Ensures information is clear, accurate and consistent with all legal, privacy, confidentiality and company standards.
• Follows through on all outstanding items in a timely basis as per service level agreements. Commitment to take ownership and to resolve client issues and concerns to the satisfaction of the client and business unit.
• Refers questionable/contentious claims to management and/or TPA client for evaluation as needed and provide recommendation for actions.
• Maintains and updates all applicable system records

• Minimum 3 years’ experience in adjudication including the investigation and detailed reporting of life insurance claims
• Demonstrated mathematical aptitude and strong data analysis skills with attention to detail and accuracy.
• Understanding of Canadian Life insurance products and applicable insurance laws
• Good verbal and written communication skills to effectively communicate with internal and external customers/partners and vendors.
• Critical thinking, customer service skills, time management, problem solving, decision-making, interpersonal skills and adaptability/flexibility.
• Pursuing ALHC, FLMI or ACS
• Must be able to work independently with little supervision in a team environment.
• Required education: Bachelor's
• Required experience: life insurance: 4 years
• Required language: French