Senior Group Benefits Operations Specialist

AGA inc.; Markham; Hybrid; CAD 65,000 - 95,000; Full time

Job summary

AGA Benefit Solutions is seeking a seasoned benefits administrator to oversee group benefits operations, eligibility and enrollment, and data integrity. You will resolve complex benefit issues for clients, insurers, and internal teams while ensuring contractual compliance and accurate plan management.

The role emphasizes analytics, experience with contracts and billing, and the ability to guide stakeholders through intricate benefit matters.

Qualifications

• Minimum of 5 years of Group Benefits administration, insurance, payroll, HR administration, data administration or related field.
• College diploma or equivalent experience.
• CEBS certification is an asset.
• Bilingualism in both official languages is an asset.
• Knowledge of Group health insurance plans for Multi-employer or Flex environment is an asset.
• Advanced computer proficiency incl. MS Office; Word and Excel and ability to learn new applications.
• Strong mathematical, analytical and problem-solving skills.
• Excellent oral, written, interpersonal, and communication skills.
• Ability to multi-task effectively and work in a team or independently.

Responsibilities

• Oversee the administration of member eligibility, enrolments, terminations, beneficiary updates, dependent changes, and other benefit transactions to ensure accuracy and compliance with plan provisions.
• Review and validate member and plan data to maintain accurate records and support effective plan administration.
• Coordinate and manage annual enrolment activities, benefit changes, and complex eligibility situations.
• Manage over-age dependent reviews and ensure eligibility requirements and supporting documentation are met.
• Prepare, validate, and transmit eligibility and benefits information to insurers and third-party providers.
• Ensure member records are maintained in accordance with privacy, confidentiality, and regulatory requirements.
• Interpret and apply group insurance contracts, policies, employee booklets, and administrative agreements.
• Audit insurer billing statements and premium calculations to ensure plan changes and rates are accurately reflected.
• Identify and resolve discrepancies between contractual requirements, insurer practices, and administration system configurations.
• Provide guidance to clients, insurers, consultants, and internal stakeholders regarding complex benefit matters.
• Analyze member, eligibility, billing, and insurer data to identify trends, discrepancies, risks, and required corrective actions.
• Reconcile information across benefit administration systems, insurer records, and client data sources.
• Conduct audits to ensure data integrity, contractual compliance, and accuracy of member and plan information.
• Investigate and resolve eligibility, coverage, enrolment, premium, billing, and administrative discrepancies.
• Prepare and review reports, analyses, and supporting documentation to support client service and decision-making.

Skills

MS Office

Analytical mindset

Group benefits knowledge

Education

College diploma

Job description

AGA Benefit Solutions is seeking a seasoned benefits administrator to oversee group benefits operations, eligibility and enrollment, and data integrity. You will resolve complex benefit issues for clients, insurers, and internal teams while ensuring contractual compliance and accurate plan management.

The role emphasizes analytics, experience with contracts and billing, and the ability to guide stakeholders through intricate benefit matters.