Claims Adjudication Representative

Myhsa-Ltd; Calgary; Hybrid; CAD 48,000 - 50,000; Full time

Job summary

Myhsa-Ltd in Canada is seeking a Claims Adjudication Representative on the Customer Experience team to review HSA and WSA claims and decide reimbursements based on plan rules and adjudication guidelines. This hybrid role requires strong attention to detail and clear communication to members.

You will work with cross-functional teams to ensure accurate decisions, maintain privacy standards, and stay updated on policy changes. The Calgary office is a key location for in-person days.

Qualifications

• Strong analytical and critical thinking.
• 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-through.
• A collaborative approach to working across teams.

Responsibilities

• 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 reimbursement decisions.
• Ensure 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.
• 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.

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.