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Claims Adjudicator

3 months ago

Remote, Canada NexgenRx Inc. Full time

**NexgenRx** is a publicly traded company, established in 2003, to answer the increasing demand for an alternative to life insurance companies, the traditional providers of drug, dental and extended health care benefits. The NexgenRx solution enables plan sponsors to better control costs and improve health outcomes for employees and their families by using leading edge communications and processing technology. **NexgenRx**is a fast paced and exciting place to work with opportunities to use and develop skills and talents and we are growing **The Company is currently looking for an Intermediate Claims Adjudicator to join our team.**

**Primary Objective**:
The Intermediate Claims Adjudicator provides timely and accurate adjudication and reimbursement of benefit claims submitted by members covered under our Client Benefit Trust Funds. They are expected to use their experience with health benefit plans, complex health claims and adjudication systems to assist the team. They will provide courteous and professional customer service while maintaining departmental standards.

**Key Responsibilities**:

- Responsible for analyzing and adjudicating health benefit plan claims according to contract provisions up to the applicable authorization limit
- Responsible for evaluating and processing claims within the service standards of the Company
- Signing off on claims processed and pended claims daily within their authorization limit
- Preparing and reviewing Dental claims (including Basic or Major as required)
- Corresponding and communicating via telephone, video call or in writing with members, consultants, providers and other internal and external customers
- Verifying data entry for accuracy and completeness
- Meeting production expectations as established by the Claims Manager

**Key Contacts/Relationships External and Internal**:

- This role reports to the Claims Manager and receives work direction from the Manager
- Corresponds with insurance providers, consultants with regards to specific claims submitted
- Works with other NexgenRx staff.

Regular office hours are 9:00 a.m. to 5:00 p.m. Monday to Friday.

**Knowledge, Skills and Abilities**:

- Analytical skills in order to research, review and assess claims
- Familiarity with contract wording, policy provisions and the Canadian Health Insurance Act
- Minimum 3 years of health and dental claims experience, including complex claims for both
- Compliant with government regulation pertaining to the Privacy Act (PIPEDA)
- Strong verbal and written English communication skills; Bilingual (French) an asset
- Strong attention to detail with exceptional organization skills
- Highly productive
- Ability to manage multiple cases simultaneously
- Ability to learn complexities of multiple benefit packages
- Community College Diploma preferred
- Experience working with union groups would be helpful
- Strong to Intermediate computer skills in the use of claims adjudication systems
- Ability to learn the complexities of the NexgenRx claims adjudication platform
- Cooperative team player with strong interpersonal Skills
- A self-leader with demonstrated initiative and eager to learn and grow in the role

**Why NexgenRx**
- Dynamic team within a growing organization
- Remote work opportunity; remotely from home office with occasional invitation to work or attend meetings in the Toronto office
- Comprehensive group benefits plan
- Opportunities for professional development
- While we appreciate all submissions, only those selected for interviews will be contacted._

**Job Types**: Full-time, Permanent

Pay: $22.50-$25.50 per hour

Expected hours: 37.5 per week

**Benefits**:

- Casual dress
- Company events
- Dental care
- Disability insurance
- Employee assistance program
- Extended health care
- Life insurance
- RRSP match
- Vision care
- Wellness program
- Work from home

Flexible Language Requirement:

- French not required

Schedule:

- Monday to Friday

Work Location: Remote

Application deadline: 2024-07-10
Expected start date: 2024-08-06