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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Life and Disability claims adjudication, with a strong ability to interpret insurance contracts and assess complex information to support sound decision-making. Proven communication skills in conveying complex decisions and rationale to diverse stakeholders, alongside a commitment to improving claims quality and efficiency.
Highest-signal resume keywords
Life And Disability Claims AdjudicationInterpretation Of Insurance ContractsComplex Information AssessmentBilingualism (English And French)Quality Assurance Reviews
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims Management PracticesDecision Rationale PreparationAppeal AnalysisRisk IdentificationProcess Improvement InitiativesMedical Information AnalysisFinancial Information AssessmentOccupational Information EvaluationContractual Information InterpretationLegislative Requirements Understanding
Soft Skills
Effective CommunicationConstructive FeedbackCollaborationProblem SolvingCustomer Experience Improvement
Industry Keywords
Life InsuranceDisability InsuranceCritical Illness InsuranceAccidental Death And Dismemberment (AD&D)Claims QualityCompliance RisksAppeal TrendsClaims ExaminersCase ManagersTeam Leaders
About the role
Key responsibilities & impact- Conduct independent reviews of appealed Life, Disability, Critical Illness, Accidental Death & Dismemberment (AD&D), and other related insurance claims
- Analyze medical, contractual, financial, occupational, and administrative information relevant to appeal decisions
- Assess the appropriateness and completeness of original claim determinations
- Render decisions to uphold, modify, or overturn previous claim outcomes
- Prepare detailed and defensible decision rationales and correspondence
- Interpret insurance contracts, policy provisions, administrative agreements, legislative requirements, and internal guidelines
- Identify and escalate legal, financial, reputational, or compliance risks
- Review claim handling practices and decision-making processes to identify risks, inconsistencies, and improvement opportunities
- Provide recommendations to improve claims quality, consistency, efficiency, and customer experience
- Monitor appeal trends and emerging issues and provide insights to leadership and operational teams
- Participate in audits, special projects, and process improvement initiatives
- Provide expert guidance and constructive feedback to Claims Examiners, Case Managers, Team Leaders, and other stakeholders
- Support development of best practices, knowledge resources, and training materials
- Communicate appeal outcomes and supporting rationale to internal and external stakeholders
- Collaborate with medical consultants, legal counsel, employers, plan sponsors, reinsurers, and other business partners
- Respond to inquiries regarding appeal decisions, processes, and policy interpretation
Requirements
What you’ll need- Post-secondary education in a relevant field such as Business Administration, Health Sciences, Nursing, Rehabilitation, Insurance, Law, or a related discipline
- Minimum of 5 years of progressive experience in Life and Disability claims adjudication, case management, appeals, or a related insurance role
- Demonstrated expertise in the interpretation and application of group insurance contracts, policy provisions, and claims management practices
- Experience assessing complex medical, contractual, financial, and occupational information to support sound claim decisions
- Strong understanding of Life, Disability, Critical Illness, and Accidental Death & Dismemberment (AD&D) products and claims processes
- Experience conducting quality assurance reviews, appeals, audits, or complex claim assessments is considered an asset
- Proven ability to communicate complex decisions and rationale effectively, both verbally and in writing
- Bilingualism (English and French) is required to perform the duties of the role
Benefits
Comp & perks- Flexible work arrangements and emphasis on work-life balance
- Comprehensive health, vision and dental plan that is 100% employer paid effective on your first day
- 100% employer-matched Defined Contribution Pension Plan
- Annual Incentive Bonus which recognizes your contribution to our success
- Paid vacation and additional Vacation Purchase Program
- Wellness benefits, health resources and fitness center discounts
- Career path encouraging you to follow your passions, learn new skills and focus on growing your career with Medavie
- Accommodations or adjustments at any stage of the recruitment process