Claims Care Analyst

What you will do
Assess claims for benefit entitlement by reviewing all relevant contractual, medical, functional, and occupational documentation in accordance with established routines and certificate provisions;
Efficiently manage an active caseload, ensuring compliance with client service standards, best practice guidelines, KPIs, and turnaround times (TATs);
Conduct thorough documentation of claim analysis and maintain accurate records as per company policies and procedures;
Communicate professionally and empathetically, both in writing and verbally, with stakeholders to provide updates, clarify claim status, and explain decisions;
Perform detailed phone interviews with clients or involved parties to gather information and discuss claim outcomes;
Identify required supporting documents for current and future benefit payments, and follow up diligently to obtain necessary information;
Collaborate with team members, plan sponsors, and other stakeholders to uphold service standards and contribute to a positive and dynamic work environment;
Participate actively in departmental projects and continuous improvement initiatives by identifying process optimization opportunities and adapting to changes;
Perform other related duties as assigned.

What you will bring
Post-secondary education or equivalent work experience; a College diploma (DEC) in a relevant field is preferred;
Professional designations such as FLHC, FLMI, or ALHC are considered assets;
Minimum of 1 year experience in insurance claims processing, particularly in life, disability, and critical illness insurance;
Medical knowledge obtained through claims assessment, underwriting, or experience in a medical or paramedical profession is an asset;
Strong proficiency in English for communication with customers and colleagues;
Strong proficiency in French for communication with customers and/or colleagues in Quebec;

Strong analytical and problem-solving skills with meticulous attention to detail and a commitment to high-quality service;
Ability to conduct sensitive phone interviews and convey decisions tactfully;
Proficiency in Microsoft Office suite (Word, Outlook) and case management software;
Ability to multitask and prioritize effectively while meeting diverse deadlines;
Professionalism under pressure, with the ability to manage stressful situations and deliver difficult news empathetically;
Positive attitude, strong team spirit, and adaptability to organizational changes.