Reporting to the Team Leader of Case Management, a Case Coordinator is primarily responsible for the case management of medical claims. The person provides active case management in direct contact with the client, facility, and repatriation providers while the emergency is occurring.  

They will advise and guide policyholders by explaining policy benefits, reviewing coverage limitations/exclusions, and approving medical consultations and testing. Case Coordinators will ensure prompt follow-up with our clients in close cooperation with the medical team.  

What does your typical day look like?

• Verbal and written communication with client/insured and family members of case plans, explain decision making and coverage benefits.  
• Be available to handle incoming calls via telephony system.  
• Handle calls for all full assistance corporate clients  
• Expected to handle communication and continued management of cases assigned to other coordinators on days off or on other calls.  
• Communicate with facilities and care providers for client updates and plans.  
• Communicate with specialized vendors related to care and repatriation requirements for the client.  
• Communicate limitation of benefits and possibility of claim denial during or at conclusion of the emergency.  
• Prioritize and distribute new cases and determine urgency and necessity of case management.  
• Continuous reassessment of priority of case risk and work   
• Work closely with the Medical team, Managed Care, Case Coordinators, and other GEM departments when applicable.  
• Coordinate direct billing and place guarantees of payment up to authority threshold.  
• Air Ambulance and Medical Escort Repatriation   
• Arrange commercial repatriation, return of vehicles and pets.  
• Manage repatriation Email Inbox  
• Setting an initial reserve, updated reserve, and final reserve accurately on inpatient and outpatient claims.  
• Review medical information to determine if further treatments are needed, review medical updates, and validate the policy wording.   
• Quickly establish an understanding of the current medical and logistics/location of situation client is experiencing.  
• Identify possible lack of access to treatment and work to arrange appropriate medical care (via transfer, evacuation, etc.). 
• Creation of a Case Plan and strategy based on information collected, that focuses on the client location, quality of care, cost avoidance and available policy benefits.  
• Complete risk assessment to make decision on level of involvement and case priority.  

• Review claims and other communications, written or oral, from clients located mostly outside Quebec.

• Contact corporate clients or policyholders, mostly from outside Quebec, to obtain information missing from their files.

• Contact healthcare professionals from around the world.

What skills and training do you need?

• College Diploma or equivalent combined with experience in customer service, telecommunication, assistance and claims, or medical field is an asset (ex. Nursing).  
• Clear and effective communication in  English and French (written and verbal); other languages such as Spanish are an asset.  
• Capacity to work with people in a fast-paced, team-based environment.  
• Must exhibit strong communication skills and professionalism.  
• Capable and confident in negotiations and problems solving skills.
• Experience with data entry software.  
• Excellent computer skills with working knowledge of Microsoft Office application and Internet.   
• Professional.   
• Excellent communication and customer service skills.
• Reliable and responsible team player.
• Personal accountability and ownership.
• Attention to detail.
• Balanced decision making and problem solving skills.
• Empathetic Outlook. 
• Flexibility.
• Positive attitude with self-confidence.
• Stress management skills.
• Result oriented.
• Understanding the corporate client culture/expectations.
• Multi-tasking.                                                                                                                                                       

When you apply:

If you require assistance or accommodation during our recruitment process, please notify Human Resources so that we can review and consider how we may be able to assist you based on your individual needs.