Member Services Representative

599 Empress St E, Winnipeg, MB R3G 3P3, Canada

Posted Monday, August 31, 2026 at 6:00 AM

About Manitoba Blue Cross

We’re a Manitoba-based, not-for-profit, health benefits provider with a vision to be the trusted and essential health and wellness partner for all Manitobans. Every dollar made is reinvested in our infrastructure, our people, and our province with the goal of providing better care for our members, expanding our community impact and broadening our health care knowledge.

Why work for us?

Manitoba Blue Cross, is a Manitoba
Top Employer. We are empowered to give back to the community, and we know that caring needs to start in our workplace with our own Manitoba Blue Cross team. We actively foster a culture that focuses on your satisfaction, development, diversity, and growth
.

Culture of Caring

We strive to succeed at reaching our organizational goals, but we always make time to celebrate our successes. Having fun as a group and rewarding our employees for their accomplishments is an essential part of our workplace culture.

We want our workforce to reflect the diverse community we serve, and we're committed to creating a fair and respectful workplace. We offer a work environment that promotes a healthy work-life balance and support to advance your career that includes:

• Fully equipped onsite fitness center.
• Casual dress code to promote diversity and inclusivity.
• Personal and professional development.

Are you a driven
, dedicated
, and enthusiastic individual who wants to work in a friendly and rewarding environment? If so, we are looking for someone like you! The following position is open to anyone residing in Winnipeg and surrounding areas with valid work authorization.

POSITION SUMMARY

The position encompasses both responding to diverse and complex inquiries from customers in person and by telephone, as well as assessing, adjudicating, and processing claims.

The incumbent requires extensive knowledge of all of the company’s products and administrative practices relating to company procedures.

DUTIES AND RESPONSIBILITIES

• Responds to customer inquiries to include enrollment and billing procedures, claims procedures and payments, and plan specific coverage inquiries.
• Confirm coverage, explain benefits and ensure claim requirements are explained and understood by both members and providers.
• Check for processed claims for dental offices, hospitals, pharmacies, and various other health providers and members, including resolution of any issues and performing any corrective action.
• Accurately complete an inquiry ticket for each call received and complete forms and memos as needed.
• Accurately adjudicate and process standard and diverse Ambulance/Hospital, Extended Health, Dental, Health Spending Account, Wellness Spending Account and Vision Care claims and pre-authorizations in accordance with performance standards.
• Assist in the management of pended claims in the Claims Workplace as assigned.
• Ensure claims/queries for clients with Service Level agreements are adjudicated within the standards set out in the agreement.
• Manage and update Coordination of Benefits (COB) information, ensuring the correct adjudication of claims.
• Return claims for completeness of information and communicate with members and providers to obtain any necessary additional information whenever possible.
• Remain current and knowledgeable about benefits which are provided by the Provincial Health Care Plan, particularly in respect to prescription drugs, travel health and vision care.
• Process Bonds of Indemnity for lost or stolen cheques, distribute explanation(s) of benefits, process or forward requests for address changes and identification cards for members to the appropriate department.
• Promote and sell Travel products.
• Ass…