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Senior Associate, Eligibility Management

Req. #:  14114
Department: Eligibility Management & Services To Plan Administrators
Location: Montreal, QC CA
Job Status: Permanent Full-time
Grade:  04
Category: Group Insurance - Health & Wellness
Description:

As part of the Regional unit of the Eligibility Management team, effectively determines the eligibility of Group Insurance participants in accordance with the contractual provisions and the established administrative norms and updates eligibility records accordingly. The incumbent is also responsible for the management of Group Insurance medical files.

By providing quality and timely services related to the post-sales maintenance activities on member eligibility records, this Team’s Business outcomes have a direct impact on client retention and profitability targets.  Team activities include reviewing electronic download reports and system updates, such as addition, terminations, changes and administrative functions associated with medical evidence of insurability files. These functions contribute to ensuring client satisfaction.  

  • Reviews documentation and administration forms from Group Insurance employees and Plan administrators and determines the eligibility to coverage in accordance with the contractual provisions and the established administrative norms.  Confirms to plan administrators if medical evidence is required.
  • Effectively proceeds with the updates of participant records in order to produce the output of Group Insurance documentation within the established turnaround time and quality standards and to adjudicate claim payments with accuracy and in a timely manner.
  • Initiates medical study where dictated by the terms of the policy and the administrative norms and requests paramedical and lab services to our external paramedical services provider when necessary, in accordance with our medical underwriting norms. Performs follow up with participants and providers when necessary.
  • Reviews systems reports generated either by transactions performed by Plan Administrator using our web site VIP Room or by electronic files sent by clients to update the eligibility records of their employees. Ensures that errors are addressed and corrected in a timely manner.
  • Communicates with various internal contacts to resolve any issue related to the eligibility records.
  • Promotes team spirit, recognition and a positive attitude focused on customer service and Total Customer Satisfaction (TCS).

REQUIREMENTS

  • College diploma in Administration with three (3) years of relevant experience.
  • Professional title (HIAA, LOMA or CEBS) is a definite asset.
  • In depth knowledge of Microsoft Office.
  • Bilingual, French and English, written and spoken.

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The personal information gathered on this website is considered strictly confidential and will be used exclusively for recruitment purposes by the Human Resources department at The Standard Life Assurance Company of Canada. Under no circumstances will this information be used for other purposes or forwarded to a third party without the candidate’s authorization.





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