Claims Adjudication Representative

myHSA LTD; Calgary; Hybrid; CAD 48,000 - 50,000; Full time

Job summary

myHSA LTD is seeking a Claims Adjudication Representative to review HSA and WSA claims and determine reimbursements based on member plans and adjudication guidelines. This role demands accuracy, fairness, and clear communication with members.

In this full-time, hybrid position, you will work from Calgary offices on weekdays, collaborate with Support and other teams, and stay current with changes to regulations and plan rules while handling sensitive information with care.

Qualifications

• Strong analytical and critical thinking to assess claims.
• Excellent attention to detail and accuracy.
• Clear written and verbal communication in a professional tone.
• Comfort with technology and learning new programs.
• Good time management with reliable follow-through.
• Collaborative approach to working across teams.
• Genuine commitment to great customer service.

Responsibilities

• Review HSA and WSA claims, verifying receipts and documentation.
• Apply eligibility criteria and plan rules for reimbursement decisions.
• Ensure decisions comply with policies, regulations, and standards.
• Communicate claim outcomes clearly to members.
• Collaborate with Support and other departments to resolve inquiries.
• Flag patterns or unclear guidelines to Adjudication Coordinators and Head of Experience.
• Participate in team discussions and process improvements.
• Stay updated with changes to guidelines and plan rules.
• Handle private and sensitive information following security standards.

Skills

Analytical thinking

Attention to detail

Communication skills

Tech-savviness

Time management

Cross-team collaboration

Customer service

Job description

As a Claims Adjudication Representative on our Customer Experience team, you’ll review Health Spending Account (HSA) and Wellness Spending Account (WSA) claims and make reimbursement decisions based on each member’s plan details and adjudication guidelines. Your decisions need to be accurate, consistent, and fair, and your communication with members needs to be clear, helpful, and respectful. If you like detail-oriented work that directly affects how people use their benefits, this role is for you.

What You’ll Do

• Review HSA and WSA claims, checking receipts and supporting documentation to confirm each claim is valid and eligible
• Apply eligibility criteria and plan rules to make consistent, well-reasoned, and unbiased reimbursement decisions
• Make sure every decision complies with internal policies, external regulations, and industry standards
• Communicate clearly with members about claim outcomes and any additional information needed
• Work with Support and other departments to resolve member inquiries smoothly
• Flag emerging patterns, unclear guidelines, or repeated issues to the Adjudication Coordinators and Head of Experience so they can be reviewed and acted on
• Take part in team discussions and process improvement work
• Keep up with changes to guidelines, regulations, and plan rules through ongoing training
• Handle private and sensitive information with care, following our security and privacy standards

What You Bring

• Strong analytical and critical thinking skills
• Excellent attention to detail and accuracy
• Clear written and verbal communication, with a professional, solution-oriented tone
• Comfort with technology and learning new programs
• Good time management and reliable follow-throughA collaborative approach to working across teams
• A genuine commitment to great customer service

Nice to have: Experience in claims, benefits, or insurance. It’s an asset but not required, we’ll train you!

Role Details

• Salary: $48,000 - $50,000/year
• Location: Hybrid, with in-office days at our Calgary office (candidates must be in Calgary)
• Schedule: Full-time, Monday to Friday

What You’ll Gain

You’ll be part of a growing benefits platform and play a direct role in shaping experiences used by businesses across Canada, with real room to learn and grow.

We support you with a comprehensive benefits package, including health, dental, vision, and spending accounts. Our vacation policy grows with you, starting at two and a half weeks and reaching four weeks of PTO after three years. You’ll have regular one‑on‑one check‑ins, clear performance management, and open feedback, so you always know where you stand and how to grow.

Our 17th Ave office is bright, recently redecorated, and stocked with good coffee, a drink fridge, snacks, and friendly people who make coming to work enjoyable.