Claims Adjudicator (4917)

Job Posting

Claims Adjudicator
Organization:  3sHealth (Health Shared Services Saskatchewan)
Province:  Saskatchewan
Location:  Regina
 
 
Description:

The Claims Adjudicator is a member of the Claims Services team responsible for assessing and managing short and long-term disability claims to resolution. This includes determining if the claimants are eligible for benefit payments and developing appropriate actions plans for each claim. The Adjudicator works in partnership with claimants, participating member organizations, unions, lawyers, physicians and vocational rehabilitation consultants. The Claims Adjudicator makes timely decisions based on medical and vocational components and plan policies, while effectively and proactively managing a caseload of ongoing claims.

Requirements:

Experience

A minimum of 5 years’ experience in insurance and/or disability claims adjudication, or an equivalent combination of education and experience.
Medical experience obtained through claims assessing, underwriting, nursing or a health profession is an asset.

Education

Post-secondary education in the field of nursing, social sciences or rehabilitation.

Knowledge, Skills & Abilities

  • Ability to establish and maintain effective interpersonal/consultative relationships including conflict resolution.
  • Ability to identify root cause of issues and develop/recommend solutions.
  • Ability to manage time and set personal goals and priorities to achieve department results.
  • Ability to understand customer needs and identifying improvement opportunities.
  • Ability to work independently and as a member of a multi-disciplinary team.
  • Effective use of MS Office Suite and database applications.
  • Excellent written and verbal communication skills, and high attention to detail.
  • Medical knowledge as well as demonstrated knowledge in aspects of human behaviour, counseling, interviewing, referral procedures and community resources.
  • Knowledge of group insurance principles and practices, industry standards, legal and contractual obligations, and claims investigation and assessment procedures an asset.
  • Ability to handle calls of a sensitive or emotionally charged nature.
  • Must have a positive attitude, a commitment to quality service and ability to cope with the stress inherent in the nature of disability claims adjudication, including high work volumes.

Other Information

  • Knowledge of lean processes would be considered an asset.

To be considered for this position, all applicants must submit a cover letter and resume by no later than August 10, 2018.

We thank all interested applicants, however, only those selected for an interview will be contacted.

Prior to being offered the position with 3sHealth, the selected candidate will be required to complete a criminal record check.