Manager, Group Health & Dental Claims

First Canadian Insurance Corporation; Edmonton; On-site; CAD 80,000 - 100,000; Full time

Benefits offered by this job

Vacation and Earned Time Off

Group Retirement Savings Plan

Health & Wellness Spending Account

On-site gym

Early finish on Fridays

Employee Assistance Program

Job summary

First Canadian Insurance Corporation is searching for a leader in claims adjudication role based in Edmonton. This role involves recruiting, onboarding, and developing a health and dental claims adjudication team while designing efficient processing workflows.

You'll collaborate closely with senior leaders to drive innovation and performance. To succeed, you need 5–7 years in claims adjudication and experience in a leadership position.

Qualifications

• 5–7+ years of hands-on group benefits health and dental claims adjudication experience.
• 1–3+ years in a leadership role overseeing a claims adjudication team.
• Strong analytical and organizational skills.

Responsibilities

• Recruit and develop a high-performing claims adjudication team.
• Design and implement claims processing workflows.
• Conduct regular claim file audits and performance reviews.

Skills

Claims adjudication

Leadership

Communication

Analytical skills

Education

Bachelor's degree in Business Administration or Human Resources

Tools

Microsoft Office Suite

Claims adjudication software

Job description

LeMarchand Mansion
Edmonton, AB T5K 0J8, CAN

Description

Bring What You Know. Help Build What's Next.

First Canadian Group Benefits is growing nationally, and we're investing in the people, technology and capabilities that will support our next stage of growth.

A division of an established Canadian financial services organization, we have the stability and resources behind us to build for the future while remaining small enough that talented people can have a meaningful influence on where we're going.

Our employees work directly with senior Group Benefits leaders, including our President and Vice President. Ideas move quickly, expertise is valued and you'll have the opportunity to see the impact of your work.

We're looking for people who want more than a narrowly defined role. People who can get into the details, solve problems and understand the operation while also stepping back, thinking strategically and asking how we can make it better.

If you've built your Group Benefits expertise and are ready to use it to help build what's next, this could be the opportunity you've been looking for.

What We Offer

• Vacation and Earned Time Off program
• Group Retirement Savings Plan with employer match
• Employee benefits plus Health & Wellness Spending Account
• Educational assistance and career development
• One-hour early finish on Fridays
• Employee Assistance Program and employee discount programs
• On-site gym
• 5% bilingualism premium for qualified professional-level French bilingualism, where applicable

Why This Opportunity is Different

Don't just lead the function. Help build it.

This isn't a role where you'll simply inherit an established playbook and manage against it.

You'll lead people and operations, but you'll also have the opportunity to influence how the function evolves - including processes, workflows, technology, service delivery, team capability and client experience.

You'll work directly with the Vice President, Claims & Administration and the President of Group Benefits, bringing your expertise into discussions about both today's operation and tomorrow's business.

We're looking for a leader who is equally comfortable coaching an employee, digging into an operational issue and stepping back to determine what needs to change strategically.

WhatYou’ll Build

• How our growing Claims function is structured and operates.
• Claims processes, workflows, quality standards and service delivery.
• Development and implementation of our Claims platform.
• Team structure, capability, coaching and future development.
• Who we hire as the Claims team grows: role design, selection and building the right mix of experience.
• How we train and onboard new examiners, including the knowledge, tools and standards they need to adjudicate confidently.
• Operational measures and practices that support quality, productivity and client experience.
• Capacity planning and service levels: how we forecast claim volumes, staff to them and hold turnaround commitments as we grow.
• Quality, privacy and compliance controls: how we protect member health information and keep adjudication decisions consistent and defensible.
• How Claims works with Administration, Technology and other areas of Group Benefits.
• Future Claims capabilities and priorities as the business continues to grow.
• Division direction beyond your own function: you'll take part in leadership and strategic planning sessions alongside the President, Vice President, Directors and fellow Managers.

Growth creates opportunity

As our business has grown, employees have had opportunities to expand their responsibilities and move into leadership positions. We're continuing to build the capabilities and leadership structure our future business will require.

Where you'll work

Our Group Benefits team works together in-office in Edmonton. We believe the stage we're at as a growing business benefits from close collaboration, immediate access to leaders and the ability to solve problems together.

What you'll do

• Recruit, onboard and develop a high-performing health and dental claims adjudication team; set clear expectations and cultivate a culture of accuracy, accountability and continuous learning.
• Design and implement claims processing workflows that ensure every claim is handled correctly, compliantly and efficiently from submission through payment or denial.
• Partner in the evaluation and selection of a new claims adjudication software platform; provide ongoing input to system development and enhancement.
• Conduct regular claim file audits and performance reviews; identify trends, flag emerging risks and turn data into process improvements.
• Serve as the escalation point for complex or disputed claims by communicating clearly with claimants and Plan Sponsors to reach fair, well-reasoned resolutions.
• Provide ongoing training so your team stays current on products, regulatory requirements and evolving best practices.
• Collaborate with the administration team and senior leadership to align claims operations with broader business objectives.
• Track and report on claims KPIs; use metrics to drive performance and surface opportunities for improvement.
• Other duties as assigned.

Qualifications:

• 5–7+ years of hands-on group benefits health and dental claims adjudication experience, with deep knowledge of claims regulations and processing standards.
• 1–3+ years in a leadership role overseeing a claims adjudication team.
• A track record of building or transforming claims operations — process design, workflow optimization, or technology implementation experience is a strong plus.
• Bachelor's degree in Business Administration, Human Resources or equivalent.
• Strong analytical and organizational skills; able to manage multiple priorities without losing attention to detail.
• Clear, confident communicator — skilled at navigating difficult conversations with claimants and stakeholders alike.
• Proficient in Microsoft Office Suite; familiarity with claims adjudication software is an asset.
• Insurance designation (LOMA, CEBS/GBA, ICA) is a significant asset.
• Bilingual English/French is an asset.
• Successful completion of pre-employment screening (criminal, credit, education, reference and designation verification) is required.

Check out our company page for all the information on why we believe First Canadian is an employer of choice!

Thank you for considering our organization.

We are an equal opportunities employer and welcome applications from all suitably qualified persons. Accommodations are available upon request.