Claims Adjuster

Position Summary:

Reporting to the Claims Supervisor the primary objective is to ensure high quality, expedient, and profitable turnaround of member claims, while ensuring a positive member experience is achieved throughout the claims process.

Job Duties/Responsibilities:

• Adjusting claims on a daily basis within claims turnaround timelines, individual productivity and quality assurance targets
• Reviewing reassessments and pre-approvals within set turnaround times daily
• Ensuring owner and pet information on claim forms corresponds with information contained in medical history and policy administration systems
• Responsible for contacting members/clinics to obtain any additional medical information required for claim completion
• Review of complete medical history relating to submitted claims to verify coverage eligibility against the selected policy
• Communicating details of processed claim to clients and veterinarians as required
• Assisting Customer Service Representatives with claims related inquiries
• Ongoing collaboration with claims and risk management team regarding best practices
• Other duties as assigned

Education/Experience:

• Bachelor’s or Associate’s in animal care or related field; CVT, LVT, or RVT is preferred,
• 2-3 years of experience working in a clinical/veterinary environment, preferably in primary care
• Strong knowledge of veterinary medical terminology, treatments, and medications
• Previous insurance experience is an asset

Required Qualifications (Certifications, Licenses, Software Programs, KSA’s):

• Ability to obtain Insurance Adjuster licensing as required
• Strong knowledge of veterinary medical terminology
• Strong communication and customer service skills
• Comfortable using a computer and proficient with Microsoft office and data entry
• Exceptional telephone and interpersonal communication skills
• Strong problem solving and de-escalation skills
• Positive attitude, highly self-motivated and goal-orientated
• Ability to work both independently and as part of a team

Additional Qualifications:

• Prior experience working in an administrative/office-based role is an asset, but not a requirement
• Must be able to pass background checks (criminal and credit)

Work Requirements:

• Frequent communications, verbal and written.
• Must be able to read, count and do simple mathematics.
• Be able to lift up to 10lbs. occasionally.
• The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc.
• Constantly operates a computer and other office productivity machinery, such as a phone with headset, calculator, copy machine, and computer printer.