Responsible for assisting with the management of a fluctuating caseload of new and ongoing creditor disability, life and critical illness claims.
iA Financial Group is the fourth largest life and health insurance company in Canada and offers a wide range of products for all stages of life and to meet the needs of clients across its vast sales network. Founded in 1892, iA Financial Group’s stability and solidity make it an employer of choice that invests in its employees and their development over the long term.
With operations across Canada and in the United States, iA Financial Group and its over 5,000 employees work hard every day to offer the best service to over four million clients.
This position is responsible for assisting the Manager, Claims Client Services and claims examiners with the management of a fluctuating caseload of new and ongoing creditor disability, life and critical illness claims primarily by responding to incoming creditor claims inquiries, set up new claims, and assist with non-adjudication tasks. In addition, the incumbent plays a role in the initial and ongoing training, as well as quality control and audits.
1. Customer Service
Effectively and efficiently respond to incoming telephone calls as our initial telephone resource.
Listen to a variety of customers' queries/complaints. Customers include claimants, financial institutions, medical & legal professionals, and occasionally, car dealerships.
Review/investigate claims system and/or claim file to identify any problem, analyze and determine course of action to rectify/respond.
Determine which queries/issues/complaints should be referred to the Claims Examiners, Specialist I & II and review with same. Follow through on any agreed upon action to ensure excellent customer service is provided.
Handle first escalation calls from Claims assistant and provide support to the Creditor claims assistant Manager.
2. Creditor Claims Validation & Initial Set-up
Check for proper completion of all new claim documents
Validate coverage for all new claims
Check Group Credit Production system for all possible certificates covering the claimant and, where appropriate, look for evidence of earlier disability claims history.
Set-up of new claim on the Claim System and via the over-night production system, produce a claims jacket.
Set-up new claim file with appropriate Certificate of Insurance, authorizations, internal forms, prior claim files, etc.
3. Claims Management Assistance
Perform routine follow-up on all correspondence by the Claim Examiners, Specialist I & II, which cannot be system generated.
Contact claimants, doctor offices, employer, financial institutions and other insurers to convey and/or gather information based on verbal or written instruction
Schedule and arrange for third party vendors to perform independent medical exams, FCEs and/or Investigations at the specific request of the Claim Examiners and Specialists. s from the adjuster.
4. Audit and Training
Initial and Ongoing training for all new creditor claims assistant, usually on an individual basis. Facilitate the integration and knowledge bases of different processes through the enforcement of System training and claim management process.
Provide Advice/direction on call referals from the claims asistants on difficult calls/complex cases.
Provide support to the Creditor claims assistant Manager by conducting monthly quality control audit and providing leadership to junior team member
Identify areas for improvement in the customer service area and communicate and recommend positive strategies to implement.
Maintain established customer service practices, be cognizant of claims and customer service practices and suggest process improvements when noted and achieve service standards.
High school diploma with 2 years post secondary education
2 years post-secondary education
Completion of LOMA Level 1, CSI, or willingness to obtain.
4 – 5 years industry-related experience or in high volume customer service environment
Insurance industry experience an asset
French and English language skills
Excellent communication skills especially verbal
Proven dedication to customer service
Good organizational skills and ability to multi-task
Sense of urgency
Demonstrate initiative and drive
Good conflict resolution, negotiation and problem-solving skills
Strong team player and willing to work well with co-workers under pressure
Good PC skills including MS Office: Word, Excel, Outlook; web-based applications
Knowledge of medical terminology an asset
Knowledge of all creditor products and variety of certificates of insurance (can be gained on the job)