Claims Adjudication Specialist

People Corporation; Winnipeg; On-site; CAD 45,000 - 55,000; Full time

Benefits offered by this job

Extended health care and dental

Retirement savings plan with company贡献

Health & Wellness offerings

Mental Health programs

Industry designations assistance

Competitive compensation

Job summary

People Corporation is seeking a Claims Adjudication Specialist to support our clients by adjudicating Health and Dental claims and answering inquiries from plan members and providers. You will verify submissions, ensure accuracy, and maintain data confidentiality while upholding service standards.

The role involves interacting via phone and email, working with adjudication systems, and participating in ongoing training to stay current with product offerings and processes.

Qualifications

• 3+ years of relevant professional experience in a service related role (Insurance, Health & Dental benefits claims).
• Demonstrated expertise in customer service, with a strong focus on anticipating, meeting, and exceeding customer needs.
• Excellent analytical skills and strong attention to detail.
• Sound knowledge of Microsoft Office and standard office administration procedures.
• Consistent and clear communication, addressing concerns respectfully with excellent verbal and written abilities.
• To make independent decisions in non-routine situations, applying guidelines effectively and considering risks and consequences.
• Experience handling multiple competing tasks accurately and efficiently, and managing time effectively.

Responsibilities

• Adjudicate Health and Dental claims up to $1,500 on the adjudication platform.
• Ensure that service standards are met or exceeded.
• Interact with plan members and service providers via phone and email to provide responses to inquiries about claims, eligibility and services.
• Obtain, analyze, and verify the accuracy of claim submissions and data.
• Initiate and/or implement correct action as needed to ensure an excellent service standard and a high level of client satisfaction maintained.
• Maintain security and confidentiality of client information.
• Actively participate in training on new product offerings and various process updates.
• Actively participates in huddles & team meetings, and share learnings in a constructive manner.

Skills

Customer service

Analytical thinking

Attention to detail

Communication

Time management

Decision making

Tools

Microsoft Office

Job description

The Claims Adjudication Specialist will actively contribute to the success of People Corporation by providing excellent service and support to our valued clients. This exciting role includes interacting with plan members and service providers to provide responses to inquiries about claims and services.

The Claims Adjudication Specialist will:

• Adjudicate Health and Dental claims up to $1,500 on the adjudication platform.
• Ensure that service standards are met or exceeded.
• Interact with plan members and service providers via phone and email to provide responses to inquiries about claims, eligibility and services.
• Obtain, analyze, and verify the accuracy of claim submissions and data.
• Initiate and/or implement correct action as needed to ensure an excellent service standard and a high level of client satisfaction is maintained.
• Maintain security and confidentiality of client information.
• Actively participate in training on new product offerings and various process updates.
• Actively participates in huddles & team meetings, and share learnings in a constructive manner.

To be successful as a Claims Adjudication Specialist with People Corporation, you will need:

• 3+ years of relevant professional experience in a service related role (Insurance, Health & Dental benefits claims)
• Demonstrated expertise in customer service, with a strong focus on anticipating, meeting, and exceeding customer needs.
• Excellent analytical skills and strong attention to detail.
• Sound knowledge of Microsoft Office and standard office administration procedures.
• Consistent and clear communication, addressing concerns respectfully with excellent verbal and written abilities.
• To make independent decisions in non-routine situations, applying guidelines effectively and considering risks and consequences.
• Experience handling multiple competing tasks accurately and efficiently, and managing time effectively.

All-star candidates will have:

• Technical knowledge on application base system.
• Fluency in both French & English would be considered an asset.

What's in it for you:

• Learn by working alongside our experts
• Extended health care and dental benefits
• A retirement savings plan with company contributions
• A suite of Health & Wellness offerings
• Mental Health programs and support for you and your family
• Assistance for the completion of industry designations
• Competitive compensation

At People Corporation we are committed to helping businesses succeed. We are a national provider of benefits, retirement, wealth, wellness, and human resource solutions. Our experts and solutions serve over 20,000 clients representing nearly 3 million Canadians. We offer customized solutions designed to fit the unique needs of businesses and their employees, members and stakeholders.

Providing an inclusive, accessible environment, where all employees and clients feel valued, respected and supported is something we're committed to. We are dedicated to building a workforce that reflects the diversity of the communities in which we live, and to creating an environment where every employee has the opportunity to reach their potential. If you require an accommodation or an alternative format of any posting please reach out to [e-mail].

The base salary for this position is between $45,000 - $55,000 annually.

This represents base salary only and does not represent other variable compensation components of our total compensation ( i.e. annual bonus, etc.). The actual base salary will vary depending on local market conditions, geography and relevant job-related factors such as knowledge, skills, qualifications, experience, and education/training. If you are selected to move forward in our recruitment process, the Talent Acquisition Specialist will be able to provide additional details of the total compensation for this role.