Jr. Claims Adjudicator

People Corporation; Toronto; On-site; CAD 40,000 - 70,000; Full time

Job summary

An established industry player is seeking a Jr. Claims Adjudicator to join their BPA team. This role focuses on the timely adjudication and reimbursement of benefit claims while providing exceptional customer service. The successful candidate will analyze claims, ensure compliance with contract provisions, and maintain high standards of accuracy and confidentiality. This position offers the opportunity to learn from experts in the field and contribute to a supportive workplace dedicated to diversity and inclusion. If you are detail-oriented and passionate about helping others, this role is perfect for you.

Benefits

Extended health care benefits

Dental benefits

Retirement savings plan

Health & Wellness offerings

Mental Health programs

Support for industry designations

Competitive compensation

Qualifications

• Strong analytical skills and attention to detail are essential for this role.
• Exceptional customer service and communication skills are required.

Responsibilities

• Analyze and adjudicate claims while maintaining a high assessment quota.
• Provide professional customer service and maintain confidentiality.

Skills

Analytical skills

Verbal communication

Written communication

Attention to detail

Customer service skills

Organizational skills

Ability to manage multiple cases

Education

Experience in medical claims field

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

AS400

CRM

Telus

Adjudicare

Job description

We are seeking a Jr. Claims Adjudicator to join our BPA team in Mississauga.

The Junior Claims Adjudicator provides timely and accurate adjudication and reimbursement of benefit claims submitted by members covered under the L.I.U.N.A. Local 183 Member’s Benefit Trust Fund. He or she provides courteous and professional customer service while maintaining departmental standards.

This position is 100% in-office.

The Jr. Claims Adjudicator will:

• Analyze and adjudicate paper or electronically submitted claims, according to contract provisions and maintaining a claims assessment quota of 140 claims per day, depending on the claim complexity
• Evaluate all claims within the 5-day service standard of the company
• Correspond and communicate via telephone, written correspondence or face-to-face with members, consultants, providers and other internal and external customers
• Apply guidelines, determine coverage, complete eligibility verification, and identify discrepancies
• Verify data entry for accuracy and completeness
• Provide Claims Team Lead with dental claims that need further review by dental consultant
• Perform data entry of claims sent to dental consultant is added and confirmed on a spreadsheet
• Maintain security and confidentiality of client records
• Be responsible for other duties as may be assigned from time to time by Management

To be successful as Jr. Claims Adjudicator with BPA, you will need:

• Analytical skills to research, review and assess claims
• Familiarity with contract wording, policy provisions and the Insurance Act
• Compliant with government regulation pertaining to the Privacy Act (PPEIDA)
• Strong verbal and written communication skills
• Strong attention to detail with exceptional organization skills
• Ability to manage multiple cases simultaneously
• Intermediate computer skills including Microsoft Word, Excel, Outlook, AS400, CRM, Telus and Adjudicare in order to enter and track program data, process claims and prepare reports and correspondence
• Exceptional customer service skills

All-star candidates will have:

• Some experience working in the medical claims field

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.

About BPA:
BPA is a division of People Corporation and has served members and beneficiaries in their local communities since 1958. BPA is dedicated to providing a superior benefits experience to our members, businesses, and trusts in the local communities in which they live and operate.

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]