Group Benefits Adjudicator

Applytojobs; Ayr; On-site; CAD 55,000 - 75,000; Full time

Benefits offered by this job

Group Benefits Plan

Growth Opportunities

In Office

Competitive Salary

Job summary

Applytojobs in Ayr, Ontario is seeking a Group Benefits Adjudicator with a minimum of 3 years' experience in group benefits claims adjudication. You will adjudicate claims, assist clients through the member portal, and support the claims processing team to ensure accurate and timely service.

The role requires strong interpersonal skills, meticulous attention to detail, and the ability to interpret plan guidelines. The position is full-time and in-office with growth opportunities.

Qualifications

• Minimum of 3 years in an insurance claims adjudication role.
• Exceptional interpersonal skills to build positive client relationships.
• Attention to detail and accurate client file maintenance.
• Ability to interpret claim guidelines in ambiguous situations.
• Team player with initiative and commitment to quality.

Responsibilities

• Adjudicate claims by collecting and reviewing information to determine legitimacy, eligibility and payout.
• Collaborate with development teams to improve adjudication processes.
• Process all claims accurately and promptly within service standards.
• Resolve client issues and concerns in a customer-service capacity.
• Refer questionable claims for evaluation and provide action recommendations to minimize fraud.
• Maintain and update all relevant system records.
• Ad hoc duties as required.

Skills

Claims adjudication

Interpersonal skills

Detail orientation

PC proficiency

MS Word

MS Excel

MS Outlook

Tools

MS Word

MS Excel

Outlook

Job description

Who are we:

We’re a Kelowna based Third Party Administrator/Payor (TPA/TPP) improving the health benefits experience for employers, insurers and, well, everybody! Our team leverages digital-focused strategies to provide members with fast, easy and thoughtful benefits experiences. To put it simply, we provide group benefits plans, but we’re a technology company first. Our team embraces autonomy, complexity and a connection between effort and reward as three qualities that foster a truly satisfying career and strive to separate ourselves from the corporate herd.

What we’re looking for:

We’re looking for a dynamic Group Benefits Adjudicator with a minimum of 3 years’ experience in group benefits claims adjudication. They are responsible for adjudicating claims in a timely and efficient way. They will be knowledgeable enough to walk clients through the member portal, understand plan designs and as well as providing claims processing assistance to the Support team!

What you’ll do:

The Group Benefits Adjudicator role is responsible for but not limited to the following:

• The adjudication of claims: collect and review all relevant information to determine legitimacy, eligibility and benefit amount payable.
• Working with the development team and product owners to develop processes and strategies for the efficient and effective adjudication of claims.
• Processing all claims accurately in a timely manner within established service standards.
• Taking ownership and resolving client issues and concerns to the satisfaction of the client and business unit, including but not limited to interacting with customers in Customer Service Capacity.
• Referring questionable/contentious claims for evaluation as needed and providing recommendations for action to help minimize fraud.
• Maintaining and updating all applicable system records.
• Ad hoc duties as required

What you need

• Must have a minimum of 3 years in an insurance company claims adjudication role.
• Exceptional interpersonal skills to build positive relationships with our clients
• Attention to detail and maintaining accurate client files
• Capable of interpreting and applying claim guidelines while working through ambiguous situations
• Dedicated team player with the ability to take the initiative, be independent with a positive attitude and dedication to quality and accuracy
• Highly organized, accurate and detail oriented; well-developed ability to perform complex mathematical calculations
• Strong organizational skills including the ability to prioritize and multi-task
• A good understanding of personal computers and software, particularly MS Word, Excel and Outlook.

What we can offer

• Group Benefits Plan
• Growth Opportunities
• In Office
• Competitive Salary
• Job Type: Full-time, Permanent

Benefits:

• Casual dress
• Dental care
• Employee Assistance Program
• Extended health care
• Life insurance
• Paid time off
• Wellness program

Schedule:

• 8-hour shift - Shift schedule could be anywhere from 8 am to 12pm start time depending on the business need at time of hire.
• Monday to Friday
• No weekends

Location:

Ayr Ontario