Claims Analyst
Core
Assess lower-risk and non-core insurance claims, adjudicate limited-risk products, and manage claim files in accordance with policy provisions and service standards.
Role type
Claims Analyst (Special Markets)
Builds
Insurance claims decisions and file documentation for Special Markets products
Domain
Insurance / Special Markets
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
policy interpretation, file management, decision-making, customer communication, documentation analysis, eligibility assessment, regulatory compliance, escalation management, knowledge of group life/health/accident/sickness plans
Preferred skills
bilingualism (English/French), insurance industry experience, critical thinking, problem-solving, stakeholder relationship building
Technologies
None explicitly stated
Responsibilities
Adjudicate non-core and lower-risk Special Markets claims within assigned authority levels; Assess eligibility and entitlement based on policy provisions and medical information; Request, review, and analyze documentation to support claim decisions; Communicate claim decisions to claimants, brokers, and internal partners; Maintain accurate claim file documentation; Identify and escalate complex or higher-risk claims; Assist with a defined portion of core products based on training and experience; Participate in claims-handling practice discussions and training activities
Seniority
Entry to Mid-level, hands-on IC