Group Health and Drug Adjudicator

Location

Ayr, ON

Job Type

Full-Time, Permanent

Who are we:
We’re a Kelowna based Third Party Administrator/Payor (TPA/TPP) improving the health benefits experience for employers, insurers and, well, everybody! Our team leverages digital-focused strategies to provide members with fast, easy and thoughtful benefits experiences. To put it simply, we provide group benefits plans, but we’re a technology company first. Our team embraces autonomy, complexity and a connection between effort and reward as three qualities that foster a truly satisfying career and strive to separate ourselves from the corporate herd.

What we’re looking for:

We’re looking for a dynamic Group Benefits Health and Drug Adjudicator Representative with a minimum of 3 year’ experience in the Benefits industry. They are responsible for handling client inquiries and processing claims in a timely and efficient way. They will be knowledgeable enough to walk clients through the member portal, understand plan designs and as well as providing claims processing assistance to the Support team!

What you’ll do:

The Group Benefits Health and Drug Adjudicator Representative will provide excellent customer service to our clients. This will include but is not limited to:

Interpret related Benefit policies and procedures and support compliance with government and provincial regulations.

Process claims and predeterminations accurately in a timely manner within established service standards.

Answer phone calls and assist members and providers with claim/coverage inquiries

Taking ownership and resolving client issues and concerns to the satisfaction of the client and business unit, including but not limited to interacting with customers in a customer service capacity.

Ability to navigate the system to efficiently answer questions around coverage, members profiles, and where needed escalate issues to the corresponding team.

Referring to questionable/contentious claims for evaluation as needed and providing recommendations for action to help minimize fraud.

Contribute to the continuous improvement of business processes.

Ensure data accuracy, integrity and consistency across designated databases

Additional basic tasks within the Support Team as required

What you need

Must have a minimum of 3 years in an insurance company, group benefits role

Must have a minimum of 1 year experience adjudicating health and drug claims.

Exceptional interpersonal skills to build positive relationships with our clients

Attention to detail and maintaining accurate client files

Capable of interpreting and applying claim guidelines while working through ambiguous situations

Dedicated team player with the ability to take the initiative, be independent with a positive attitude and dedication to quality and accuracy

Highly organized, accurate and detail oriented; well-developed ability to perform complex mathematical calculations

Strong organizational skills including the ability to prioritize and multi-task

Certification:
None required although GBA or Group Benefits Certification would be considered an asset

A good understanding of personal computers and software, particularly MS Word, Excel, Outlook and G Suite

What we can offer

Group Benefits Plan

In Office

Job Type: Full-time, Permanent

Dental care

Employee Assistance Program

Extended health care

Life insurance

Paid time off

Wellness program

Schedule:

8-hour shift – Shift schedule could be anywhere from 8 am to 12pm start time depending on the business need at time of hire.