Claims Adjuster

3 weeks ago


Ontario, Canada Kelly Services (Canada), Ltd. Full time

Kelly has partnered with our client in the Insurance Industry to recruit for a Claims Adjudicator contractor.


Job ID Number 13535

Job Title: Claims Adjudicator I

Dates: Sept. 17/24 to Mar. 29/25

Hours: Mon – Fri 9am-5pm EST 37.5 hours/week

Pay Rate: $20.00/hour

Location: Remote – Open to candidates across Canada but must work EST hours


Typical Day in the Role:

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


  • 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
  • Establish and maintain quality customer service within our turnaround times using influence with internal and external clients to meet all pre-established service standards in order to delight our customers
  • Commitment to Financial Efficiency and Continuous Improvement targets, as required
  • Commitment to improving NPS (customer) scored based on overall goals


Supporting the business:

  • Sound knowledge and ability to apply appropriate risk management tools and techniques
  • Actively participate in various projects that improve effectiveness and efficiency in claims practices in keeping with our culture of continuous improvement
  • Manage all issues and requirements related to the claim to achieve customer/claim resolution handing off only as appropriate (claims adjustments, warranty investigation, technical decisions)


MUST HAVE:

  • Exceptional communication skills: proficient in both verbal and written communication for diverse internal and external audiences
  • Proficiency in Microsoft Officer 365: Strong working knowledge of the Office 365 suite of programs
  • Detail-Oriented 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
  • Team and Individual Effectiveness: Proven ability to work effectively both independently and as part of a team in a fast-paced environment


Soft skills

  • Strong customer service focus
  • Ability to take initiative
  • Excellent interpersonal skills and the ability to interact and work with others at all levels to achieve customer resolution


Nice-to-Have Skills:

  • Bilingual English/French is an asset
  • Previous claims adjudication and/or relevant insurance or health care industry experience
  • Previous call centre and/or data processing experience


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