Evaluate the eligibility of claims by reviewing all relevant contractual, medical, functional, and professional documentation, in accordance with established procedures and the terms of the insurance certificates;
Manage an active caseload efficiently while meeting service standards, best practices, key performance indicators (KPIs), and processing timelines;
Maintain thorough documentation of claim assessments and keep accurate files in accordance with company policies and procedures;
Communicate professionally and with empathy, both verbally and in writing, to provide updates, clarify claim status, and explain decisions;
Conduct detailed telephone interviews with clients or other stakeholders to collect necessary information and discuss claim outcomes;
Identify supporting documents required for current and future payments, and perform follow-ups to obtain requested information;
Collaborate with team members, plan sponsors, and other partners to maintain high service standards and contribute to a positive, dynamic work environment;
Actively participate in departmental projects and continuous improvement initiatives by identifying opportunities to optimize processes and adapting to change;
Perform other related duties as assigned.

Postsecondary education or equivalent work experience; a college diploma (DEC) in a relevant field is an asset;
Professional designations such as FLHC, FLMI, or ALHC are considered assets;
Minimum of one year of experience in insurance claims processing, particularly in life, disability, and critical illness insurance;
Medical knowledge gained from claims management, underwriting, or a medical/paramedical profession is an asset;
Excellent analytical and problem-solving skills, strong attention to detail, and a commitment to high-quality service;
Excellent command of English for communication with clients and colleagues;
Excellent command of French for communication with clients and/or colleagues in Quebec;
Ability to conduct sensitive telephone interviews and communicate decisions with tact;
Good proficiency with Microsoft Office (Word, Outlook) and claims management systems;
Ability to manage multiple priorities simultaneously while meeting various deadlines;
Professionalism under pressure, with the ability to handle stressful situations and deliver difficult decisions with empathy;
Positive attitude, strong team spirit, and adaptability to organizational change.

Flexible work arrangements with monthly financial allowances to support work–life balance;
A generous number of paid days off at hire, plus additional days off for each year of service;
One paid volunteer day to support a cause you are passionate about;
Paid personal and wellness days to support overall well-being;
Education assistance of up to $3,500 per year (with manager approval);
Flexible Health and Wellness account (in addition to comprehensive drug and dental coverage) to help cover a wide range of wellness services important to you;
Up to 14% combined employer contributions to an RRSP matching plan;
Maternity/parental leave support for families; and
Additional benefits and programs.

Claims Processing Analyst

Key skills