Junior Claims Adjudicator (Term)

People Corporation•Vaughan, ON

2d•Onsite

About The Position

We are hiring a Junior Claims Adjudicator to join our BPA team in Vaughan. This is a term position ending on February 7, 2027. The Junior Claims Adjudicator provides timely and accurate adjudication and reimbursement of benefit claims submitted by members covered under the L.I.U.N.A. Local 183 Member’s Benefit Trust Fund. They provide courteous and professional customer service while maintaining departmental standards. This is a full-time, in-office position with hours from Monday to Friday, 8:30 a.m. to 4:30 p.m.

Requirements

Analytical skills to research review and assess claims.
Familiarity with contract wording, policy provisions and the Insurance Act.
Compliant with government regulation pertaining to the Privacy Act (PPEIDA).
Strong verbal and written communication skills.
Strong attention to detail with exceptional organization skills.
Ability to manage multiple cases simultaneously.
Intermediate computer skills in the use of related computer applications including Microsoft Word, Excel, Outlook, AS400, CRM, Telus and Adjudicare in order to enter and track program data, process claims and, prepare reports and correspondence.
Participation in company sponsored insurance programs such as FLMI, ACS, ALHC, C.E.B.S. and successful completion of these courses of study during tenure in the position.
Cooperative team player with strong interpersonal skills.
Exceptional customer service skills.

Nice To Haves

Proficiency in Portuguese, Italian, or Spanish will be considered an asset.

Responsibilities

Responsible for analyzing and adjudicating paper or electronically submitted claims, according to contract provisions and maintaining a claims assessment quota of 140 claims per day, depending on the claim complexity.
Responsible for evaluating all claims within the 5-day service standard of the Company.
Correspond and communicate via telephone, written correspondence or face-to-face with members, consultants, providers and other internal and external customers.
Apply guidelines, determine coverage, complete eligibility verification, and identify discrepancies.
Verify data entry for accuracy and completeness.
Provide Claims Team Lead with dental claims that need further review to dental consultant.
Data entry of claims sent to dental consultant is added and confirmed on a spreadsheet.
Maintain security and confidentiality of client records.
Other duties as may be assigned from time to time by Management.