Bilingual Disability Appeal Specialist

This is a fully remote position, open to applicants in Canada.

📋 Description

• Perform independent assessments of appealed Life, Disability, Critical Illness, Accidental Death & Dismemberment (AD&D), and other related insurance claims.

• Evaluate medical, contractual, financial, occupational, and administrative data pertinent to appeal decisions.

• Analyze the validity and thoroughness of initial claim determinations.

• Make decisions to affirm, amend, or overturn prior claim results.

• Draft comprehensive and defensible decision rationales and correspondence.

• Interpret insurance policies, contractual provisions, administrative agreements, legislative mandates, and internal guidelines.

• Recognize and escalate potential legal, financial, reputational, or compliance risks.

• Review claims handling procedures and decision-making processes to uncover risks, inconsistencies, and areas for improvement.

• Offer recommendations aimed at enhancing claims quality, consistency, efficiency, and customer satisfaction.

• Track appeal trends and emerging issues, providing insights to leadership and operational teams.

• Engage in audits, special projects, and initiatives for process enhancement.

• Provide expert advice and constructive feedback to Claims Examiners, Case Managers, Team Leaders, and other relevant stakeholders.

• Assist in the development of best practices, knowledge resources, and training materials.

• Communicate appeal results and supporting rationales to both internal and external stakeholders.

• Collaborate with medical consultants, legal advisors, employers, plan sponsors, reinsurers, and other business partners.

• Address inquiries concerning appeal decisions, processes, and policy interpretations.

⛳️ Requirements

• Post-secondary education in a relevant field such as Business Administration, Health Sciences, Nursing, Rehabilitation, Insurance, Law, or a related discipline.

• A minimum of 5 years of progressive experience in Life and Disability claims adjudication, case management, appeals, or a similar insurance role.

• Proven expertise in interpreting and applying group insurance contracts, policy provisions, and claims management practices.

• Experience in assessing intricate medical, contractual, financial, and occupational information to support sound claim decisions.

• Strong knowledge of Life, Disability, Critical Illness, and Accidental Death & Dismemberment (AD&D) products and claims processes.

• Experience conducting quality assurance reviews, appeals, audits, or complex claim assessments is considered an asset.

• Demonstrated capability to effectively communicate complex decisions and rationales, both verbally and in writing.

• Bilingualism (English and French) is required to fulfill the responsibilities of the role.

🏝️ Benefits

• Flexible work arrangements with a strong focus on work-life balance.

• Comprehensive health, vision, and dental plan that is fully employer-funded from your first day.

• 100% employer-matched Defined Contribution Pension Plan.

• Annual Incentive Bonus that acknowledges your contributions to our success.

• Paid vacation along with an additional Vacation Purchase Program.

• Wellness benefits, health resources, and discounts for fitness centers.

• Career development opportunities encouraging you to pursue your passions, acquire new skills, and advance your career with Medavie.

• Accommodations or adjustments available at any stage of the recruitment process.