Call Centre Operations - Supervisor, Claims & PreDeterminations
About The Position
The Supervisor, Claims & Predeterminations will lead a team responsible for the adjudication of dental and health benefit claims, ensuring accurate, timely, and compliant processing across a portfolio of programs. You’ll oversee the day‑to‑day operations, reinforce quality assurance standards, coach for consistency, and handle escalations with sound judgment. Operating within a Certified B Corporation environment, you model purpose‑driven leadership—embedding accountability, transparency, and fairness into policies, procedures, and claimant interactions. Success looks like: clear SLAs met or exceeded, audit‑ready files, seamless partner/provider collaboration, and a culture of continuous improvement that measurably lifts accuracy and client experience.
Requirements
- 3–5 years of experience in dental and/or health insurance claims processing
- Minimum 1–2 years of experience in a supervisory, team lead, or coaching role.
- Experience monitoring KPIs, compliance, audit results, and/or performance dashboards.
- Demonstrated experience providing coaching, feedback, and performance management.
- Experience working with adjudication systems and familiarity with dental coding and health benefits programs.
- Familiarity with expense management systems, claims software, financial databases, and quality assurance platforms.
- Experience of supporting onboarding and training of new staff.
- Understanding of expense processing strategies, compliance standards, and financial stewardship best practices.
- Diploma or degree in Dental Administration, Health Sciences, Insurance Adjudication, or related field, or an equivalent combination of education and relevant experience.
Nice To Haves
- Experience working with vulnerable or marginalized populations is an asset.
Responsibilities
- Provide daily leadership to the Claims team, ensuring accurate, timely expense processing and reporting.
- Support and resolve inquiries from clients, dental offices, and healthcare providers with professionalism and empathy.
- Collaborate with cross‑functional teams (Provider Relations, Administrative Services, Contact Centre, Compliance) to maintain smooth operations.
- Monitor KPIs (processing times, compliance, audit results, accuracy) and take corrective action as needed.
- Deliver ongoing coaching and feedback to build team capability, accuracy, and professionalism.
- Oversee onboarding and training to ensure consistent understanding of policies, workflows, and service standards.
- Handle escalated or complex expense issues, ensuring timely and positive stakeholder outcomes.
- Reinforce consistent workflows, documentation standards, and regulatory requirements.
- Partner with Management to identify trends, gaps, and process‑improvement opportunities.
- Lead continuous improvement initiatives and encourage staff-driven enhancements to processes and service.
- Support change initiatives by communicating updates and guiding adoption of new tools or processes.
- Assist with resource and capacity planning to maintain service levels and balanced workloads.
- Foster a collaborative, accountable, growth‑oriented team culture.
- Maintain confidentiality and privacy of all information.
- Perform other duties as assigned.
Benefits
- Contract employee plan coverage begins on the employee's first day.
- In a company that promotes from within.
- Employees can earn a "1,500 reward for successful referrals of other employees.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
