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Lead Claims Analyst
3 months ago
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 part of our BPA team in Halifax.
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 providing professional and courteous customer service while adhering to departmental standards.
Key Responsibilities of the Senior Claims Evaluator:- Analyze and adjudicate claims in accordance with contract stipulations and provider agreements, handling amounts up to $2,500.
- Ensure all claims are evaluated within the company's 5-day service standard.
- Engage in communication 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.
- Ensure data entry is accurate and complete.
- Achieve monthly production targets on a daily and weekly basis.
- 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.
- Willingness to learn the complexities of various benefit plans.
- Intermediate proficiency in relevant computer applications, including Microsoft Word, Excel, Outlook, the administration system (MEBS), and the claims adjudication system (TELUS) for data entry, claims processing, and report preparation.
- A collaborative team player with strong interpersonal skills.
- Willingness to assist with reception coverage as needed.
- Flexibility to perform additional duties as assigned.
- Gain knowledge by collaborating with our industry experts.
- Comprehensive health care and dental benefits.
- A retirement savings plan with employer contributions.
- A range of Health & Wellness offerings.
- Mental health programs and support for you and your family.
- Support for completing 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, impacting nearly 3 million Canadians. We offer tailored solutions designed to meet the distinct needs of businesses and their employees, members, and stakeholders.
About BPA:
BPA, a division of People Corporation, has been serving members and beneficiaries in their local communities since 1958. Our commitment lies in delivering an exceptional benefits experience to our members, businesses, and trusts within the communities they operate.
We are devoted 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 mirrors the diversity of the communities we serve, ensuring every employee has the opportunity to reach their full potential.
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