Job Description
Permanent Full Time
We are looking for a Bilingual (French & English) Claims Review Specialist.
Reporting to the Supervisor, Claims Review, the Claims Review Specialist is a key member of the Audit and Claim Verification team responsible for completing claim audit processes for a key Canada Life client. The main function of a Claims Review Specialist is to conduct standard claims reviews of providers and members. The Claims Review Specialist will also handle escalations and non-responses from other units within Canada Life.
What You Will Do
- 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 provide...