Career Opportunity Role Title Bilingual Claims Adjudicator Purpose of role As a Member of the Claims team, the incumbent will be accountable for ensuring that all claims are adjudicated and administered according to state and provincial law and regulations and, in a fair, ethical and efficient manner. Job Description Key Responsibilities Adjudicate various types of complex claims, including Life, Critical Illness, Disability, Member Ship Benefits and Accelerated Death Benefit claims. This includes identifying, collecting and reviewing all relevant information needed to determine the claim legitimacy and eligibility as well as the benefit amount payable. Familiarization with the requirements of the appropriate provincial/state legislation and/or regulations related to the type of claim being reviewed. Perform all necessary benefit calculations and ensure all related activities are in compliance with provincial/state statutory and internal standards. Communicate effectively both verbally and written with outside resources such as but not limited to medical consultants, legal consultants, independent physicians, coroners, police or investigative services. Determine which claims need to be referred for evaluation and decision, based on authority limits, business case issues or referral to legal counsel. Maintain and update system records as necessary. Key Qualifications Education (minimum required): College Diploma or University Degree an asset Experience (minimum required): 3-4 years’ experience adjudicating life insurance and living benefit claims. Bilingual (French) required Knowledge of claims adjudication theory, principles, methods, systems, processes and standards including an understanding of insurance medicine and actuarial principles/methods as they relate to the claims function. Knowledge of the interpretation and application of claims adjudication regulations across Canada Self-starter with demonstrated ability to prioritize case load and ability to research/problem solve and make decisions both independently and collaboratively within a fast-paced team environment Advanced verbal and written communication skills to effectively communicate with internal and external customers/partners and vendors. Strong reasoning and judgment to balance commitments, financial soundness and quality customer focus Strong analytical skills for research, review and assessment of claims. LOMA/ALHC designation an asset #LI-Hybrid Equal Opportunity Employment and Inclusion – at Foresters Financial, we are committed to sustaining an equal opportunity environment for all job applicants. We embrace Inclusion, Diversity and Equity (IDE) as a core strategic objective for building strong, innovative teams in which all our employees can show up wholly and authentically as themselves. Foresters Financial strives to provide an accessible candidate experience for prospective employees with different abilities. If you anticipate needing any type of accommodations during the recruitment process, please email accommodations@foresters.com in advance of your appointment. Thank you for choosing Foresters. Only those candidates who will be selected for further consideration will be contacted by our Talent Acquisition Team. Foresters Financial™ is an international financial services provider with a unique history that began in 1874 when we set out to provide access to life insurance for average, working families. More than 150 years later, we provide life insurance, savings, retirement and investment solutions that help families achieve long-term financial health and security.
