Health Claims Benefits Specialist

3 weeks ago

Regina, Canada The Co-operators Full time

**Position Overview**:
**Company**:CLIC

**Number of Positions**: 1

**Language**: Bilingualism in English and French is an asset.

**Work Model**:Hybrid

**Alternate Title**: n/a

**Additional Information**:
**The Opportunity**:
We are a leading Canadian financial services co-operative committed to being a catalyst for a sustainable and resilient society and our team is essential to deliver on this strategy. That’s why we prioritize our people, to ensure we provide a strong culture and development opportunities which enables our team to thrive and to live our purpose. The best part is that you will work with people that care passionately about you, our clients, and our communities.

Our Group Benefits team is a leader in our target markets through service excellence and innovative technology and products. Influenced by our co-operative values, our team of experts work collaboratively with clients to deliver solutions that meet their business needs.

The Health Claims Benefits Specialist proactively audits Extended Health and Dental claims to detect and prevent Benefits Fraud. You will identify and investigate fraudulent activity and liaise with internal partners, providers, and vendors. You will participate in CLHIA fraud initiatives and develop business procedures based on data outcomes. You will also be the first point of contact with Allianz to ensure a seamless process for emergency out of country claims.

**How you will create impact**:

- Perform audits on claims submissions and verify appropriate documentation and validation of services incurred. Develop summary reports based on the collection of evidence and communicate findings to the affected parties.
- Investigate claiming patterns and resolve disputes around claims settlements.
- Maintain successful relationships with the out of country provider, Allianz, plan administrators and insured members.
- Review files, accurately record activity and report activity to appropriate associations where required.
- Develop and present fraud awareness programs related to audit outcomes and claiming patterns.
- Correspond audit outcomes to plan members.
- Ensure the highest degree of accuracy and attention to detail is maintained, while recording errors on the appropriate database.
- Participate in CLHIA working groups and recommend change to business process based on learnings.

**How you will succeed**:

- You have an innovative mindset to improve operational efficiencies and the ability to influence change, with a primary focus on client needs.
- You use critical thinking skills to recognize and differentiate assumptions, evaluate arguments, draw conclusions, and proactively propose solutions.
- You have strong communication skills to clearly convey messages.
- You build trusting relationships, provide guidance to and support internal and external clients.

**To join our team**:

- 3 to 5 years experience in Group Benefits
- Completion of post-secondary technical or industry equivalent (1-2-year program) are recommended.
- Working towards LOMA (FLMI) designation.
- International Claims Association (ICA) designation would be considered an asset.
- Possess a good understanding of EHC and Dental products, as well as the claim adjudication process.

**What you need to know**:

- You will handle sensitive information where a high degree of confidentiality and discretion is required.

**What’s in it for you?**:

- Training and development opportunities to grow your career.
- Flexible work options and paid time off to support your personal and family needs.
- A holistic approach to your well-being, with physical and mental health programs and a supportive workplace culture.
- Paid volunteer days to give back to your community.
- A comprehensive total rewards package, including competitive salary, bonus, pension and benefits.

**Interested in applying?**:
Co-operators is focused on fostering an inclusive, equitable and accessible work environment and we encourage individuals from all identity groups to apply. If you require an accommodation during the recruitment process, please contact the hiring manager.

  • Mental Health Claims Consultant

    1 week ago

    Regina, Canada Co-operators Life Insurance Company Full time

    Close Date: June 5, 2024 Company: CLIC Department: Group Benefits Employment Type: Regular Full-Time Work Model: Hybrid Language: English is required, French is an asset. Job Grade: 5 Hiring Manager: Sarah Dulong Referral Award: No **The Opportunity**: We are a leading Canadian financial services co-operative committed to being a catalyst for a...

  • CA- Content Claims Specialist

    1 week ago

    Regina, Canada Crawford & Company Full time

    Position Summary We are currently recruiting for an Content Claims Specialist to join our Edjuster team in Regina, Saskatchewan, Canada.  The role of Content Claims Specialists is a multi-faceted role, which focuses primarily in the following four key areas of edjuster’s content claims handling operations: With a high focus on customer service,...

  • CA- Content Claims Specialist

    4 days ago

    Regina, Canada Crawford & Company Full time

    Position Summary We are currently recruiting for an Content Claims Specialist to join our Edjuster team in Regina, Saskatchewan, Canada. The role of Content Claims Specialists is a multi-faceted role, which focuses primarily in the following four key areas of edjuster’s content claims handling operations: With a high focus on customer service,...

  • CA- Content Claims Specialist

    4 days ago

    Regina, Canada Crawford & Company Full time

    Position Summary We are currently recruiting for an Content Claims Specialist to join our Edjuster team in Regina, Saskatchewan, Canada. The role of Content Claims Specialists is a multi-faceted role, which focuses primarily in the following four key areas of edjuster’s content claims handling operations: With a high focus on customer service,...

  • CA- Content Claims Specialist

    5 days ago

    Regina, Canada Crawford & Company Full time

    Position Summary We are currently recruiting for an Content Claims Specialist to join our Edjuster team in Regina, Saskatchewan, Canada. The role of Content Claims Specialists is a multi-faceted role, which focuses primarily in the following four key areas of edjuster’s content claims handling operations: With a high focus on customer service,...

  • Director, Claims

    3 weeks ago

    Regina, Canada HK Henderson Full time

    THE ROLE As the Director, Claims & Compliance, you are focused on managing specialized work efficiently, with confidence and competence. The position requires above average attention to details, with a somewhat faster-than-average pace. You will need an understanding of insurance rules and regulations, experience in claims management, and overall desire...

  • Director, Claims

    3 weeks ago

    Regina, Canada HK Henderson Full time

    THE ROLE As the Director, Claims & Compliance, you are focused on managing specialized work efficiently, with confidence and competence. The position requires above average attention to details, with a somewhat faster-than-average pace. You will need an understanding of insurance rules and regulations, experience in claims management, and overall desire...

  • Director, Claims

    2 weeks ago

    Regina, Canada HK Henderson Full time

    THE ROLE As the Director, Claims & Compliance, you are focused on managing specialized work efficiently, with confidence and competence. The position requires above average attention to details, with a somewhat faster-than-average pace.You will need an understanding of insurance rules and regulations, experience in claims management, and overall desire to...

  • Director, Claims

    3 weeks ago

    Regina, Canada HK Henderson Full time

    THE ROLEAs the Director, Claims & Compliance, you are focused on managing specialized work efficiently, with confidence and competence. The position requires above average attention to details, with a somewhat faster-than-average pace.You will need an understanding of insurance rules and regulations, experience in claims management, and overall desire to...

  • Manager, Claims

    1 month ago

    Regina, Canada Saskatchewan Government Insurance Full time

    Do you value integrity and innovation? How about passion and caring? Great! Us too, and that's why you'll fit right in. Our intentional culture promotes trust and participation, encouraging you to bring your heart and mind to work every day. Location: 100% In-Office Saskatchewan (Regina, Saskatoon, Estevan, Kindersley, Lloydminster, Meadow Lake, Moose Jaw,...

  • Summer Student

    1 week ago

    Regina, Canada Group Medical Services Full time

    Come join a team that truly takes care of our customers, our communities and each other? All in all, we're a pretty awesome bunch to work with! **Here's the role** As a Claims Assessor, you will be responsible for processing GMS claims submitted through our multiple mediums in order to ensure claims payments are made within our standard turnaround. Do you...

  • Claims Examiner Iii Reinsurance

    1 month ago

    Regina, Canada Canada Life Assurance Company Full time

    Claims Examiner III Reinsurance **Description: - Permanent Full Time- As a Claims Examiner III, you’ll provide senior level adjudication of Reinsurance and Retrocession Individual Life and Health (DI & Waiver) claim decisions. Every day could look a little different as you perform a range of tasks to support the claim team by resolving client inquiries,...

  • Non-insured Health Benefits Analyst

    1 week ago

    Regina, Canada Indigenous Services Canada Full time

    Indigenous Services Canada - First Nations and Inuit Health Branch Regina (Saskatchewan) CR-05 - Inventory $61,154 to $66,206 For further information on the organization, please visit Indigenous Services Canada **Closing date: 2 March 2025 - 23:59, Pacific Time** **Who can apply**: Persons residing in Canada, and Canadian citizens and Permanent residents...

  • Rehabilitation Partnership Specialist

    1 month ago

    Regina, Canada Saskatchewan Government Insurance Full time

    Do you value integrity and innovation? How about passion and caring? Great! Us too, and that's why you'll fit right in. Our intentional culture promotes trust and participation, encouraging you to bring your heart and mind to work every day. - InScope, Full-time - Permanent Opportunity - Location: Regina (Hybrid or In-office) - Hybrid means you’ll have the...

  • Claims Technical Analyst

    6 days ago

    Regina, Canada Saskatchewan Government Insurance Full time

    Do you value integrity and innovation? How about passion and caring? Great! Us too, and that's why you'll fit right in. Our intentional culture promotes trust and participation, encouraging you to bring your heart and mind to work every day. - In Scope - Location: Any of SGI Offices located in Saskatchewan or Manitoba) - This role is eligible for hybrid....

  • Property Claims Adjuster

    2 days ago

    Regina, Canada Avenue Living Asset Management Full time

    Avenue Living Asset Management is dedicated to sourcing, analyzing, and strategizing long-term investments. Our unique approach has led to rapid growth across North America now representing one of Canada’s largest alternative asset managers. Since 2006, we have acquired over $5.5 billion in assets under management across a variety of sectors throughout...

  • Mental Health

    1 month ago

    Regina, Canada Regina Catholic School Division Full time

    Position Title - **Mental Health & Wellness Specialist 0.50 FTE Riffel High School** As a school division, we are dedicated to the journey of Truth and Reconciliation. We are engaging all division staff, providing professional development, and providing authentic experiences for students. In a Catholic environment that fosters collegiality and supports...

  • Rehabilitation Partnership Specialist

    4 weeks ago

    Regina, Canada Saskatchewan Government Insurance Full time

    Do you value integrity and innovation? How about passion and caring? Great! Us too, and that's why you'll fit right in. Our intentional culture promotes trust and participation, encouraging you to bring your heart and mind to work every day. - InScope, Full-time - Permanent Opportunity - Location: Regina (Hybrid or In-office) - Hybrid means you’ll have the...

  • Manager, Payroll

    4 weeks ago

    Regina, Canada Saskatchewan Government Insurance Full time

    Do you value integrity and innovation? How about passion and caring? Great! Us too, and that's why you'll fit right in. Our intentional culture promotes trust and participation, encouraging you to bring your heart and mind to work every day. Out of Scope Location: Regina Head Office General Accountability Key Accountabilities Note: This section is not...

  • Disability Case Manager

    1 month ago

    Regina, Canada Canada Life Full time

    Job Description We are looking for a Disability Case Manager Are you looking for an environment where integrity, partnership, excellence and constant improvement are at the heart of your everyday life? In our organization, we believe in working collaboratively in a team environment to share our knowledge with one another and to coach and mentor...