Claims Examiner
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Job Summary
Claims Examiner
Bilingual English & Portuguese
Epic Health Solutions boasts over 35 years of experience in the healthcare industry providing innovative solutions in an ever-evolving marketplace. As part of an award-winning enterprise group were proud to support a global team of more than 500 employees dedicated to enhancing healthcare services.
We are seeking a detail-oriented bilingual Claims Examiner to join our Travel Insurance team at Epic Health this role you will review investigate and adjudicate travel insurance claims while communicating professionally with insureds brokers and medical facilities in both English and Portuguese. This position is essential to maintaining claims accuracy and supporting our operational goals.
- Review investigate and adjudicate Travel Insurance claims (Medical Trip Cancellation/Interruption/Delay Baggage Loss/Damage/Delay) in accordance with policy terms and conditions
- Communicate effectively and professionally in both English and Portuguese with insureds agents/brokers medical facilities and other stakeholders to collect documentation and explain claim status and decisions
- Analyze medical records and other supporting evidence to determine coverage and validity of claims
- Respond to claim inquiries and complaints from insureds and brokers in a timely courteous manner
- Maintain accurate reserves and ensure timely updates to the claims management system
- Draft clear accurate and compliant claim denial letters that cite applicable policy language in both English and Portuguese as needed
- Participate in quality reviews training and continuous improvement initiatives
- Perform other duties as assigned
- 2-3 years of experience in claims examining or adjusting insurance claims (Travel Health or related field)
- Bilingual fluency in English and Portuguese (spoken and written) required; must be able to professionally read write and speak with agents medical facilities and brokers in both languages
- Strong understanding of travel insurance policies and benefits considered an asset
- Excellent analytical problem-solving and decision-making skills
- Strong attention to detail and accuracy
- Strong written and verbal communication skills
- Ability to prioritize tasks and manage deadlines in a fast-paced environment
- Proficiency with MS Office
Claims Adjudication Customer Service Excellence Accuracy and Attention to Detail Communication Time Management Accountability Problem Solving Teamwork Professionalism
If you are passionate about insurance and want to contribute to meaningful healthcare solutions we invite you to apply today and become part of our dedicated team at Epic Health Solutions!
Job Type | Full-time |
Expected Hours | 40 per week |
Schedule | 8-hour shift Day shift Monday to Friday |
Work Location | Hybrid |
Language Requirements | English and Portuguese |
- Dental care
- Employee assistance program
- Extended health care
- Life insurance
- On-site parking
- Paid time off
- RRSP match
- Vision care
Epic Health Solutions is committed to providing an inclusive and accessible work environment and complies with the Accessibility for Ontarians with Disabilities Act (AODA). We are dedicated to ensuring equal opportunities for all applicants. If you require accommodations during the recruitment process please email us at and we will work with you to meet your needs.
