Bilingual Claims Adjudicator (Insurance) — 100% Remote (TOR, ON)

Recrute Action

1d•Remote

About The Position

Build your experience in the insurance industry by supporting the assessment and processing of health and dental claims within a fast-paced transformation project. This fully remote opportunity offers exposure to cloud-based systems, collaboration within a close-knit team, and strong potential for long-term career growth and professional development.

Requirements

Bachelor’s degree in Business or a related field.
0–2 years of professional experience.
Strong proficiency with Microsoft Office 365 applications.
Strong analytical and detail-oriented skills, including the ability to review receipts, extract data, and accurately enter information.
Excellent verbal and written communication skills for interacting with diverse audiences.
Ability to work independently and collaboratively in a fast-paced environment.
Strong customer service orientation and interpersonal skills.
Ability to take initiative and manage priorities effectively.
Bilingual in English and French to support communication with internal and external clients while maintaining high-quality customer service standards.

Nice To Haves

Experience reviewing and adjudicating insurance claims, including verifying policy coverage and determining eligibility for settlement, is an asset.
Previous experience within the insurance, health care, call center, or data processing industries is an asset.
Experience collaborating with legal, medical, or external service providers is an asset.

Responsibilities

Assess complex health and dental claims in accordance with contract provisions and established service standards.
Review claims for completeness, enter and assess claim information, and determine payment responsibility after insurance benefits are applied.
Make decisions that may impact member benefit entitlement and payable amounts.
Manage assigned claims while prioritizing urgent cases effectively.
Deliver high-quality customer service within established turnaround times.
Communicate effectively with internal and external stakeholders to meet service expectations and support customer satisfaction.
Contribute to financial efficiency and continuous improvement objectives.
Support initiatives aimed at improving customer satisfaction and Net Promoter Score (NPS) results.
Apply appropriate risk management tools and techniques in daily activities.
Participate in projects focused on improving claims processing effectiveness and operational efficiency.
Resolve claims-related issues and coordinate appropriate escalation when required, including claims adjustments and technical decisions.
Support Business As Usual (BAU) activities during the transition from a legacy system to a cloud-based platform.