Senior Claims Evaluator
4 weeks ago
Position Overview
This role requires full-time on-site presence.
Working Hours: 8:30 AM to 4:30 PM, Monday through Friday.
We are looking for a Senior Claims Evaluator to become a part of our BPA team.
The Senior Claims Evaluator is responsible for the prompt and precise assessment and reimbursement of benefit claims submitted by members enrolled in our clients' Benefit Trust Funds. This role demands a courteous and professional approach to customer service while adhering to departmental standards.
Key Responsibilities:
Analyze and adjudicate claims in accordance with contract stipulations and provider agreements, up to a limit of $2,500. Ensure all claims are evaluated within the company's 5-day service standard. Communicate effectively via phone, written correspondence, or in-person with members, consultants, providers, and other internal and external stakeholders. Apply guidelines, assess coverage, verify eligibility, and identify any discrepancies. Confirm data entry for accuracy and completeness. Achieve monthly production targets on a daily and weekly basis.Qualifications for Success:
2-3 years of experience in adjudicating medical, dental, vision claims, or accident benefits claims. Strong analytical skills for researching, reviewing, and evaluating claims. Excellent verbal and written communication abilities. Outstanding customer service skills. High attention to detail and exceptional organizational capabilities. Ability to manage multiple cases concurrently. Capacity to understand the complexities of various benefit plans. Proficient computer skills, including familiarity with Microsoft Word, Excel, Outlook, and relevant claims adjudication systems. Team-oriented with strong interpersonal skills. Willingness to assist with reception duties as needed. Flexibility to perform additional tasks as assigned.Benefits of Joining Us:
Opportunity to learn alongside industry experts. Comprehensive health and dental benefits. Retirement savings plan with employer contributions. A variety of Health & Wellness programs. Mental health support for you and your family. Assistance in pursuing industry designations. Competitive salary package. At People Corporation, we are dedicated to empowering businesses to thrive. As a national provider of benefits, retirement, wealth, wellness, and human resource solutions, our expertise serves over 20,000 clients, representing nearly 3 million Canadians. We offer tailored solutions designed to meet the unique needs of businesses and their employees, members, and stakeholders.
About BPA:
BPA, a division of People Corporation, has been committed to serving members and beneficiaries in their local communities since its inception. We strive to deliver an exceptional benefits experience to our members, businesses, and trusts in the communities they inhabit.
We are committed to fostering an inclusive and accessible environment where all employees and clients feel valued, respected, and supported. Our goal is to build a workforce that reflects the diversity of the communities we serve, ensuring every employee has the opportunity to reach their full potential.
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