Team Lead - Sr Claims Examiner


With more than 180,000 people in over
40 countries, Capgemini is a global leader in consulting, technology and
outsourcing services. The Group reported 2015 global revenues of EUR 11.9
billion. Together with its clients, Capgemini creates and delivers business,
technology and digital solutions that fit their needs, enabling them to achieve
innovation and competitiveness. A deeply multicultural organization, Capgemini
has developed its own way of working, the Collaborative Business Experience™,
and draws on Rightshore®, its worldwide delivery model.

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Capgemini is an Equal Opportunity
Employer encouraging diversity in the workplace. All qualified applicants will
receive consideration for employment without regard to race, national origin,
gender identity/expression, age, religion, disability, sexual orientation,
genetics, veteran status, marital status or any other characteristic protected
by law.

This is a general description of the
Duties, Responsibilities and Qualifications required for this position.
Physical, mental, sensory or environmental demands may be referenced in an
attempt to communicate the manner in which this position traditionally is
performed. Whenever necessary to provide individuals with disabilities an equal
employment opportunity, Capgemini will consider reasonable accommodations that
might involve varying job requirements and/or changing the way this job is
performed, provided that such accommodations do not pose an undue hardship.

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skills and responsibilities:

Location: Horsham


for supporting claim activities by coordinating Independent Medical
Examinations (IME’s) and Functional Abilities Evaluations (FAE’s) in a timely
manner for Life & Health Claims. Responsible for supporting claim
activities by providing administrative assistance to the support services unit
for Life & Health Claims. Credentialing vendors and collaborating with
nurses, doctors and claims adjudicators to facilitate expert medical

skills and responsibilities:

for coordinating the Independent Medical Evaluations and Functional Abilities
Evaluations process and for ensuring service delivery within the established
timeframes Responsible
for making travel arrangements and accommodations to facilitate the IME/FAE
process as requiredResponsible
for processing payments for all investigative, rehab, and medical related vendor
invoices on approved invoicesResponsible
for re-credentialing the IA provider annually and updating the database with
ongoing changes as appropriate throughout the yearResponsible
for record keeping and statistical reporting Provides
general and ongoing administrative support to doctors, rehab and clinical
specialists within the support services unitServing
as the back-up to the Support Services Assistant as requiredTake
ownership of client problems through first call resolution coaching and escalate
as appropriateGiven
the very sensitive nature of the information gathered in the adjudication
process, extreme care must be exercised in the handling of a claim in order to
guard against any breach of confidentialityUtilize
vendors effectively to maintain cost effectiveness and appropriate risk
management strategiesProactively
partner with claim adjudicators, Doctors and Rehabilitation Specialists to
deliver effective service solutionsAdheres
to departmental service excellence standardsOperate
within company and legal regulations regarding PIPEDA, fraud, confidentiality,
and private health information.Other
duties may be assigned.