Posted 8 days ago
Description
It's fun to work in a company where passion meets profession, and every team member is not just an employee but a dedicated enthusiast, making the work journey truly enjoyable and fulfilling!
About Us:
We are seeking ambitious individuals who share our values and passion for making a positive impact on people's lives around the world. If you are looking for a career that challenges and inspires you, you've come to the right place.
About You:
The Quality Auditor is responsible for coding accuracy, benefit payment, policy interpretation, and compliance with policies and procedures. The Quality Auditor will ensure that claims that are process are within the policy threshold. They will contribute and coordinate testing activities as well as troubleshoot and solve testing problems effectively and efficiently.
In this role, you’ll get to experience:
- Process travel insurance claims for medical, trip cancellation/interruption, baggage, dental and vision claims up to the designated limit
- Conduct claims audits to validate accuracy as well as compliance with contract terms and conditions
- Gather and compile data from multiple sources
- Review claims, complete investigations, and report on findings
- Maintain complete and accurate documentation of all audits related information
- Contribute to achieving team objectives and delivery on service level commitments including all SLA’s
- Analyze claims to determine if processed claims are within the policy threshold, identify errors, and make recommendations
- Maintain complete and accurate documentation of all audit related information, reports and conversations
- Apply audit standards and follow directions on properly applying `yes/no’ questions to determine accuracy
- Investigate, develop, and apply changes to Operations to the audit documents
- Conduct quality audits of claims, pre and post payments, utilizing appropriate sources of information, including eligibility, enrollment, and contracts
What you bring:
- Excellent communication skills in French and English
- Ability to manage confidential information and protect privacy
- Post-secondary education or related experience equivalent.
- Minimum 3-5 years experience of Quality Assurance.
- Claims adjudicator/examiner experience is an asset
- Excellent working knowledge of computer programs.
- Superior verbal and written communication skills.
- Attention to detail
- Maintains current knowledge of plan language, benefit issues, client and Organization’s policies and requirements
- Demonstrates pursuit of ongoing education, certification and self-development to remain current with industry standards and business objectives related to case management and leadership skills.
Preferred Skills:
- Lean/Six Sigma
- Experience in Medical Insurance industry
- Experience in Travel or Major Medical industry.
- Experience with United States Medical system.
- Experience with non-North American medical system.
- Previous Case Management experience.
- Medical terminology, clinical experience or Nursing education.
- Knowledge of multiple business areas or products and supporting systems
What’s in it for you:
- Hybrid work environment
- Excellent health benefits
- Employee assistance program
- Wellness account
- Minimum 3 weeks’ vacation
- Generous sick and flex days
- Opportunities to learn new skills, grow, and move into different roles
- A work environment that embraces diversity and promotes inclusivity.
- Supportive leadership prioritizes your success and cares about your well-being.
- A growth trajectory that is designed to expand both vertically and horizontally, providing you with opportunities to pursue your passions and acquire new skills.
MSH is an Equal Opportunity Employer
MSH Americas is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other protected status under applicable law. We encourage and welcome applicants from all backgrounds to apply for our open positions.
Removing obstacles to offer fair access to jobs is our top priority. When a candidate asks for reasonable accommodation throughout the application process, a Human Resources professional will assist them. The information provided during the accommodation request process will be handled, saved, and utilized by the laws that apply to it as well as the rules of MSH International.
