Jr. Claims Adjudicator

3 days ago

North York, Canada People Corporation Full time

We are seeking a Jr. Claims Adjudicator to join our BPA team in North York.

The Junior Claims Adjudicator provides timely and accurate adjudication and reimbursement of benefit claims submitted by members covered under the L.I.U.N.A. Local 183 Member’s Benefit Trust Fund. He or she provides courteous and professional
customer service while maintaining departmental standards.

**The Jr. Claims Adjudicator will**:

- Responsible for analyzing and adjudicating paper or electronically submitted claims, according to contract provisions and maintaining a claims assessment quota of 140 claims per day, depending on the claim complexity.
- Responsible for evaluating all claims within the 5-day service standard of the Company.
- Correspond and communicate via telephone, written correspondence or face-to face with members, consultants, providers and other internal and external customers.
- Verify data entry for accuracy and completeness.
- Provide Claims Team Lead with dental claims that need further review to dental consultant.
- Data entry of claims sent to dental consultant is added and confirmed on a spreadsheet.
- Maintain security and confidentiality of client records.
- Other duties as may be assigned from time to time by Management.
- Reports to Claims Supervisor, Team Lead and Operations Manager.
- Receives work direction from Claims Supervisor and Claims Team Lead.
- Corresponds with insurance providers, consultants, and Union Representatives with regards to specific claims submitted.
- Work cooperatively as a member of the L.I.U.N.A. Local 183 Trust administration team to provide superior customer service.

**To be successful as a Jr. Claims Adjudicator **with BPA, you will need**:

- Analytical skills to research review and assess claims.
- Familiarity with contract wording, policy provisions and the Insurance Act
- Compliant with government regulation pertaining to the Privacy Act (PPEIDA).
- Strong verbal and written communication skills.
- Strong attention to detail with exceptional organization skills.
- Ability to manage multiple cases simultaneously.
- Microsoft Word, Excel, Outlook, AS400, CRM, TELUS and Adjudicate in order to enter and track program data, process claims and, prepare reports and correspondence.
- Participation in company sponsored insurance programs such as FLMI, ACS,
- ALHC, C.E.B.S. and successful completion of these courses of study during tenure in the position.
- Cooperative team player with strong interpersonal skills.
- Exceptional customer service skills.

**What's in it for you**:

- Learn by working alongside our experts
- Extended health care and dental benefits
- A retirement savings plan with company contributions
- A suite of Health & Wellness offerings
- Mental Health programs and support for you and your family
- Assistance for the completion of industry designations
- Competitive compensation

At People Corporation we are committed to helping businesses succeed. We are a national provider of benefits, retirement, wealth, wellness, and human resource solutions. Our experts and solutions serve over 20,000 clients representing nearly 3 million Canadians. We offer customized solutions designed to fit the unique needs of businesses and their employees, members and stakeholders.

About BPA:
BPA is a division of People Corporation and has served members and beneficiaries in their local communities since 1958. BPA is dedicated to providing a superior benefits experience to our members, businesses, and trusts in the local communities in which they live and operate.

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