Appeals Associate

March 13 2019
Industries Bank, Insurance, Financial services
Categories Legal, Paralegal, Professionals (other)
Kitchener, ON

Job Purpose/Role:

Reporting to the Supervisor, Appeals, the Appeals Associate is responsible for managing the appeals processes for the Claims department and provide the management team with recommendations for claims process changes by drawing on appeals trends. The successful candidate will provide written analysis and develop criteria and documentation to clarify the claims processes in order to reduce the volume of appeals cases.

What you will be doing:

Manage the appeals process for various claim groups from investigation to claims payment or maintenance of the claims denial decision.

  • Investigate appeals to determine merit and make recommendations to pay or maintain the denial and profile the decision to management and/or underwriters when applicable.
  • Forward the appeal review and applicable documentation to the medical department and/or Claims Legal Counsel to request another medical review and/or claims and legal analysis when required.
  • Create various correspondence to clients to request further information and/or to outline internal decisions made for payment or non-payment of claims.
  • Develop and document guidelines for discretionary payment of appeals according to criteria from both client policies and the company.
  • Communicate the final decision to clients regarding appeals.
  • Collect and analyze the monthly appeals report in order to flag cases or claims that warrant internal review.
  • Support the Claims Department on projects and other initiatives to support business needs as required.

What skills and experience we require:

  • College Diploma/Degree (legal discipline preferred) plus two to three years’ experience in a similar related function.
  • Proficient letter writing skills with proven ability to adapt and modify written skills based on type of customer.
  • Excellent written and verbal communication skills; able to influence and interact with internal and external clients.
  • Self-motivated and ability to work with minimal supervision.

What We Offer You:

  • Support to grow your career in the insurance industry
  • Room for advancement and opportunity
  • A fun and supportive environment
  • Flexible work schedule

Applicants must be eligible to work in Canada for the duration of the contract. Proof of eligibility for temporary roles may include: a Canadian birth certificate, Canadian passport, Canadian citizenship certificate, permanent residence card or confirmation and/or a Canadian work permit, which authorizes you to work for the duration of the assignment, and would include having a valid Social Insurance Number.

Application Process:

At Allianz Global Assistance, you will feel good about your career, the company, and positively impacting people’s lives. At Allianz Global Assistance, you will feel at home. Allianz Global Assistance offers a very competitive total rewards package. If you are interested in applying for this or any other opportunity, please visit our Careers’ page at

Regrettably, due to the volume of applications received, only those applicants being considered for an interview will be contacted.

Please no agencies

All successful candidates must be able to pass an Enhanced Reliability Check performed by the Government of Canada.

Allianz Global Assistance Canada is an Equal Opportunity Employer.

If you may require accommodation in completing the application process please email or call our toll free number 1-800-461-1079 and ask to speak to a member of the Human Resources Recruiting Team. If you are contacted regarding this position, please advise the Recruiter of accommodation measures you may require during our selection process. Information received relating to accommodation needs of applicants will be addressed confidentially.

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