Group Benefits Claims Adjudicator (Bilingual)

EIO Solutions

3d•Remote

About The Position

At EIO, we help small businesses deliver better employee benefits and workplace experiences—supporting employee well-being while enabling employers to attract and retain top talent. Our approach is practical and data-driven, grounded in what we call Employee Investment Optimization. As part of our fully remote team, you’ll enjoy flexibility, competitive compensation and benefits, and opportunities for professional growth within a collaborative and high-performing environment. We’re proud of the culture we’ve built and are entering an exciting phase of growth. If you’re thoughtful, motivated, and interested in contributing to meaningful work, EIO offers a place to build and grow your career. Join us and be part of what’s next. We are seeking a Group Benefits Claims Adjudicator and Benefits Support Specialist to support our TPA operations. In this role, you will be the heartbeat of our health and dental claims processing including HCSA, Wellness and Cost-Plus, ensuring that member inquiries are resolved quickly and adjudications are handled with precision. Working closely with our insurance carriers and partners, you’ll help maintain our high standards of service in a fully remote, fast-paced environment.

Requirements

Bilingualism: Fluency in French and English (written and verbal) is required.
1–3+ years in claims adjudication, benefits administration, or a TPA/insurance environment.
Experience with TELUS Adjudicare is a very strong asset; comfort using HubSpot or similar ticketing systems is preferred.
A solid understanding of Canadian extended health and dental plans (Life, AD&D, Health, Dental, HCSA).
Ability to interpret plan designs and assist with the creation of complex benefit booklets and ASO/HSA plan structures.
Proven ability to work independently and stay organized in a fully remote setting.

Nice To Haves

Detail-oriented professional with a foundation in group benefits, who loves helping people and solving puzzles.
Claims assistant or a customer service representative in the insurance space looking to specialize in TPA operations.
Take immense pride in accuracy and delivering a "wow" experience for members.
A problem-solver who enjoys digging into plan documents to find answers.
Thrive in a hands-on environment where you manage your own desk and priorities.
Communicate clearly and empathetically in both French and English.
Want a remote role where you can grow your technical knowledge of Canadian benefits.

Responsibilities

Executing daily claims adjudication and providing direct support to our members.
Managing member inquiries and tickets using HubSpot Helpdesk.
Following and refining internal SOPs to ensure seamless benefits administration.
Coordinating with insurance carriers and TELUS claims partners to resolve routine processing issues.
Collaborating with the EIO team on projects
Act as the first point of contact for member inquiries via HubSpot, resolving tickets related to coverage and claims and supporting members as needed to complete applications for provincial drug programs.
Handle daily health and dental claims processing ensuring accuracy and alignment with specific plan documents.
Coordinate with insurance carriers and TELUS Adjudicare to troubleshoot submission errors or eligibility issues.
Assist in documenting and updating internal workflows to keep our operations running smoothly.
Support group setup, plan member onboarding, and data entry within our administration systems if needed.
Provide high-quality support in both French and English
Maintain strict adherence to privacy and regulatory requirements (PHIPA / PIPEDA).
Assist with the creation of new group benefits booklets and updates and review to get to know the plan designs