Junior Claims Adjudicator and Client Care

EIO Solutions

1d • Remote

About The Position

We are seeking a Bilingual Health and Dental Claims Adjudication & Customer Service Representative to support our TPA operations and member service functions. In this role, you will be the heartbeat of our health and dental claims processing, 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. In this role, you’ll be: 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. Who This Role Is Perfect For This role is ideal for a detail-oriented professional with a foundation in group benefits, who loves helping people and solving puzzles. You might currently be a claims assistant or a customer service representative in the insurance space looking to specialize in TPA operations. You’ll do well in this role if you: Take immense pride in accuracy and delivering a "wow" experience for members. Are 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.

Requirements

• Fluency in French and English (written and verbal) is required.
• 1–3 years in claims adjudication, benefits administration, or a TPA/insurance environment.
• 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

• Experience with TELUS Adjudicare is a very strong asset; comfort using HubSpot or similar ticketing systems is preferred.

Responsibilities

• Handle daily health and dental claims processing ensuring accuracy and alignment with specific plan documents.
• Act as the first point of contact for member inquiries via HubSpot, resolving tickets related to coverage and claims.
• 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.
• Provide high-quality support in both French and English for a diverse member base.
• Maintain strict adherence to privacy and regulatory requirements (PHIPA / PIPEDA).

Benefits

• Fully Remote: Work from anywhere in Canada.
• Growth Potential: Gain deep technical expertise in a growing organization.
• Impact: Your work directly helps members navigate their health and wellness benefits.
• Modern Tools: Work with a tech-forward stack (HubSpot, TELUS, Slack) instead of legacy systems.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed
• Number of Employees: 1-10 employees