Manager, Group Health Claims

Equitable•Waterloo, ON

23h•CA$66,000 - CA$99,000•Hybrid

About The Position

At Equitable, we believe work should be a place where you feel supported, inspired, and empowered to grow. In our caring and collaborative environment, your curiosity is encouraged, your passion is recognized, and your contributions truly matter. Together, we create meaningful impact, for our clients, our communities, and each other. The Opportunity: At Equitable, we believe great things happen when we work together. We’re a Canadian mutual company driven by purpose - putting people first and helping Canadians protect today and prepare for tomorrow. If you’re passionate about making a difference and growing your career in an inclusive and collaborative environment, we’d love to hear from you. Our culture is built on care, passion and curiosity. We put people above all else, strive to be our best and welcome new ideas to deliver positive outcomes. This is a high-impact leadership role within Group Health Claims, where you will drive operational excellence, lead a high-performing team, and optimize claims processes to enhance service, efficiency, and cost effectiveness. You’ll play a key role in delivering strategic initiatives, improving performance, and strengthening collaboration across teams and partners. Join one of the region’s top employers and be part of something that truly makes a difference.

Requirements

Post-secondary education or an equivalent combination of education and relevant work experience
5–7 years of progressive leadership experience, ideally within group health claims or insurance environments
Strong medical and drug knowledge, with in-depth understanding of group health benefits, contracts and applicable legislation
Demonstrated ability to lead, mentor and develop high-performing teams in a fast-paced operational setting
Proven experience managing workflows, optimizing processes and driving continuous improvement initiatives
Excellent interpersonal and relationship management skills, with the ability to collaborate across internal teams and external partners
Strong analytical, problem-solving and decision-making skills, with the ability to manage competing priorities and deadlines
Effective communication skills, both written and verbal, with the ability to influence and engage stakeholders at all levels
Experience with project management and cross-functional initiatives; familiarity with agile methodologies is an asset
Solid understanding of budget management, forecasting and cost control practices
Strong attention to detail, organizational skills and ability to manage complex operational tasks
Proficiency in Microsoft Office (especially Excel and Word) and experience with systems such as BMS and OnBase is an asset
Change leadership mindset with the ability to guide teams through transformation and continuous improvement initiatives

Nice To Haves

familiarity with agile methodologies is an asset
experience with systems such as BMS and OnBase is an asset

Responsibilities

Lead and manage the day-to-day operations of the Group Health Claims team to ensure claims are processed accurately and within established service standards
Provide leadership, coaching and direction to a team of claims adjudicators, including performance management, conflict resolution and career development
Allocate and monitor team workload to ensure optimal staffing levels and timely completion of daily, weekly and monthly deliverables
Partner with the leadership team to achieve key performance indicators and continuously improve operational efficiency
Develop and oversee training programs, ensuring staff accuracy, knowledge development and cross-functional capability building
Drive and implement cross-functional projects focused on improving processes, reducing costs and increasing overall effectiveness
Act as the primary point of contact for internal and external audits, coordinating activities, reviewing findings and implementing corrective actions
Collaborate with external partners to maintain a strong and effective claims management ecosystem
Identify and implement ongoing process improvements to enhance service quality and operational efficiency
Manage escalated claims issues and provide resolution for complex cases, ensuring strong client and stakeholder relationships
Oversee reporting of operational metrics and performance data, applying insights to improve team outcomes
Manage departmental budgets, monitor expenses and identify opportunities for cost optimization
Ensure compliance with industry regulations, company policies and governance standards
Maintain strong relationships with internal departments, group offices and third-party providers to support service delivery
Stay informed on industry trends, legislative changes and competitor practices through involvement in industry forums and associations
Partner closely with the Dental Claims Manager to align resources and achieve shared team objectives