Manager, Claims and Administration

People Corporation•Toronto, ON

9d•CA$100,000 - CA$120,000•Hybrid

About The Position

The Manager, Claims Management is responsible for overseeing and directing the Claims Management department. This role ensures benefit adjudication and administration systems are functioning correctly, programming of plan details is captured accurately, and claims are adjudicated and administered efficiently and timely. The position involves supporting and directing team members to effectively resolve member inquiries and escalated issues, acting as a liaison between Team Leads, Executives, and Clients, and ensuring all departmental processes and procedures comply with regulatory requirements.

Requirements

Demonstrates strong leadership by motivating teams, fostering collaboration, and aligning performance with organizational goals.
Effectively manages people by setting clear expectations, delegating responsibilities, and supporting team development.
Possesses strong analytical skills and the ability to interpret data to make informed recommendations.
Communicates effectively in both written and verbal formats while guiding and influencing team performance.
Maintains proficiency in Microsoft Office (especially Word and Excel).
Ensures accurate data handling.
Applies relevant regulations within the claims process.
Bachelor’s Degree or College Diploma in Business, Administration or related.
3-5 years prior experience working in the benefits industry is required.
2+ years’ experience leading a team.

Nice To Haves

Certified Employee Benefits Specialist (CEBS) designation or working towards completion is an asset.

Responsibilities

Conducts a daily review of system related problems and issues escalated by members and takes effective action to resolve them.
Ensures the benefit adjudication system is up-to-date, including adjusting dollar values as rates of coverage change or benefit improvements are made.
Manages turnaround times on adjudication and allocates resources based on workload, or advises the Team Lead to reallocate resources for urgent or high-priority situations.
Sets target metrics for claims adjudication and addresses any issues related to not meeting these targets.
Works with a 3rd party TPP company to create new plan or member cards by completing required forms to set up the appropriate template and metrics for coverage.
Reviews monthly “unclaimed property” lists provided by 3rd parties and assigns them to a team member to confirm if a cheque should be issued or if the 3rd party should move the unclaimed funds to the Bank of Canada.
Reviews monthly “terrorist watch” lists received from insurance carriers and provides timely responses to any questions regarding members.
Evaluates monthly “delisted clinic” listings received from insurance carriers and updates the system or distributes them to Claims Adjudicators to verify claims against the list.
Conducts a review prior to issuing payments for each payment cycle for Disability and Life claims to ensure proper deductions are made and related files are up to date.
Confirms Global is the plan sponsor and provides final signature on LTD applications.
Ensures that all plan accounts are set up and appropriate access permissions are granted to team members.
Manages the efficiencies and outputs of the call centre by reviewing the queue for “Hold” times, abandoned calls, and understanding the reasons for abandonment.
Creates schedules to ensure sufficient coverage for Customer Care Specialists’ breaks, lunch, vacation, and sick time.
Acts as the primary escalation point and main contact when Customer Support Specialists are unable to resolve problems arising from member emails or phone calls.
Oversees claims processes including pay direct, eligibility escalations, and reporting (e.g., disabled members).
Manages payment cycles, final sign-off for any cheque/EFT approvals, and rate updates within the system.
Coordinates with accounting and external stakeholders to ensure accurate and timely payments.
Supports tax processes (T4), including corrections and communication with CRA and members.
Recruits, develops, and supports the Claims Management team to drive performance and engagement.
Provides coaching, training, and ensures compliance with regulations and best practices.
Oversees onboarding and continuous development of team members.
Prepares and delivers communications to members, unions, and internal stakeholders.