Senior Claims Assessor

505 Coughlin Winnipeg; Winnipeg; On-site; CAD 50,000 - 53,000; Full time

Job summary

Coughlin & Associates Ltd. seeks a Senior Claims Assessor to join our team in Winnipeg, MB or Ottawa, ON.

You will adjudicate and process member claims, advise on benefits, respond to inquiries, and provide mentorship to Claims staff, serving as back-up to senior roles in the department. You will apply policies to adjudicate claims, prepare reports, verify eligibility and codes, and communicate clearly with members, carriers, and clients.

Qualifications

• Post-secondary education completed.
• Minimum 3+ years in health and dental claims adjudication or benefits administration.
• Strong knowledge of medical and dental terminology.
• Leadership abilities and team mentorship.

Responsibilities

• Adjudicate and process member health and dental claims per policies.
• Respond to inquiries regarding claims and benefits.
• Mentor and guide Claims Assessors; provide performance feedback.
• Verify eligibility, codes, deductibles, and payments; prepare ad hoc reports.
• Investigate discrepancies, overpayments, and complaints; take corrective actions.

Skills

Leadership

Communication

Attention to detail

MS Office

Education

Post-secondary education in related field

Experience in health/dental claims adjudication

Tools

Microsoft Office Suite

Job description

Senior Claims Assessor

We are seeking a Senior Claims Assessor to join our Coughlin & Associates team in Winnipeg, MB or Ottawa, ON. The Senior Claims Assessor is responsible for adjudicating and processing member claims in accordance with established policies and procedures, responding to inquiries regarding claims and benefits, and providing mentorship and guidance to team members. Additionally, the Senior Claims Assessor acts as a back‑up to other senior positions in the Claims Department.

The Senior Claims Assessor will: Technical Activities & Communication Process paperless and traditional claims using the claims system to properly identify missing information on forms. Administer Cost-Plus Plans or Health Care Spending Accounts, including the preparation of adhoc reports for the use of the Consulting department. Produce claims payments, including applying applicable deductibles. Calculate the conversion of Canadian funds into foreign funds. Verify eligibility of members, drugs, services, providers, co‑insurance, deductibles, payments, and procedure/dental codes, including reviewing previous submissions and group contracts/policies. Review and verify cheques, correspondence, forms, addresses, and reports for accuracy and completion. Investigate complaints, over and underpayments, and take corrective action. Interpret policies and administrative practices and correctly apply them in the adjudication of claims. Perform data entry related to claims and member correspondence. Additionally, preparing correspondence for members, carriers, or clients using company standard templates. Respond to clients, members, or other external contacts in a prompt, efficient, and courteous manner at all times. Provide accurate and timely information/assistance to members and clients concerning coverage, processing and paying claims, and benefits parameters.

Staff Support & Mentorship Review and audit the work of Claims Assessors, ensuring accurate completion of tasks required by an internal audit. Provide general guidance and training to new staff to use the claims system, to understand the policies and procedures of the department, and to provide excellent customer service Mentor and support staff while resolving discrepancies and recommending measures to improve productivity and quality.

Qualifications

• Completion of post‑secondary education in a related field.
• Minimum 3+ years of work related experience in health and dental claims adjudication or benefits administration.
• Sound knowledge of medical and dental terminology in the concept of group or individual benefits administration.
• Strong leadership abilities, including coordinating workflow, training subordinates, motivating a team and individual performance, and assisting in performance evaluations.
• Strong working proficiency with the Microsoft Office Suite and standard office administration procedures.
• The demonstrated ability to learn and master new software and technology.
• Excellent grammatical, spelling, and communication skills.
• Strong mathematical skills and attention to detail.
• Excellent organizational skills, with the ability to prioritize and manage time effectively.
• The ability to use tact and discretion to maintain information in the strictest of confidence.

All‑star candidates will have

• Training in industry related courses provided by CEBS (Certified Employee Benefits Specialists), LOMA (Life Office Management Association), the ICA (International Claims Association).
• Bilingual proficiency in both English and French languages is considered an asset.
• Experience processing electronic claims.

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

About Coughlin & Associates Ltd.

Across the country, thousands of Canadians rely on Coughlin & Associates Ltd. to design and administer their group medical, dental, disability, life insurance and pension benefits. Coughlin is a full‑service benefits consultant and third party administrator. Our services include: Group benefits consulting and plan marketing Plan administration and correspondence Claims adjudication and payment. Established in 1958, Coughlin & Associates Ltd. provides services to some of Canada’s most respected companies, unions and public service organizations. 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 $50,000 - $53,000 annually. This represents base salary only and does not represent other variable compensation components of our total compensation ( i.e. annual bonus, commission 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.

We know that it’s the vast expertise and commitment of our teams in People Corporation and our Partner Firms that have put us where we are today. We value our employees and provide competitive salaries, a comprehensive group benefits plan, and a generous retirement savings plan. And we’re in it for the long haul - once you join us, we want you to thrive. If you want to make a difference in the lives of customers, if you take pride in a job well done, and if you like to have fun, talk to us.