Claims Adjudicator

3 weeks ago

Canada Infotek Consulting Services Inc. Full time

Infotek Consulting is searching for several Group Benefits Claims Adjudicators - this is a REMOTE contract assignment - must work on EST


• Business group: Group Benefits Canada. The successful candidate will support group benefits for health and dental, catering to policies of all sizes, including corporate and small business.

• Project: The candidate will assist with Business As Usual (BAU) activities. The group is transitioning from a legacy system to a cloud-based system and requires additional resources to process health and dental claims.


Typical Day in Role

The Claims Adjudicator is accountable for handling claims in accordance with high service standards to meet or surpass client expectations. The Adjudicator is required to make a number of determinations that may affect the member’ entitlement to benefits and/or the amount of benefits that are payable. The Adjudicator reviews claims for completeness, enters, and assesses claims, and produces the final statement and/or payment responsibility, after the member’s insurance benefits are applied to a claim.

• Outline all daily duties, responsibilities, tasks, and accountabilities

• Assesses highly complex health/dental claims in keeping with contract provisions, taking initiative and ensuring that empowered decision making is a key component of the process.

• Assume ownership of the claims assigned with an understanding of the urgency of specific cases and effectively prioritize work accordingly.

Candidate Requirements/Must Have Skills:

1) Exceptional Communication Skills: Proficient in both verbal and written communication for diverse internal and external audiences.

2) Proficiency in Microsoft Office 365: Strong working knowledge of the Officed 365 suite of programs.

3) Detail-Orientated with Quick Assessment Skills: This role requires a keen eye for detail, as it involves reviewing receipts, extracting data, and accurately inputting information into the system. An analytical mindset is essential to understand and make decisions based on the information presented.

4) Team and Individual Effectiveness: Proven ability to work effectively both independently and as part of a team in a fast-paced environment.

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