Claims Management Professional

4 weeks ago


Calgary, Alberta, Canada Recruitment Partners Full time
Group Benefits Claims Manager, Health and Dental

Our client is seeking a seasoned Group Benefits Claims Manager, Health & Dental to lead their team in Edmonton. The ideal candidate will bring extensive experience in health and dental claims management, combined with proven leadership skills to build a high-performing team.

As the Group Benefits Claims Manager, you will play a pivotal role in designing and optimizing claims processes, ensuring regulatory compliance, while providing exceptional service to members and other stakeholders, all while exceeding performance metrics.

Your success will be defined by your ability to:

  • Assist in the evaluation of new claims adjudication partners
  • Provide input to influence and shape continued development on our new administration system
  • Establish, mentor, and lead a new claims management team by fostering a collaborative environment that prioritizes accuracy, efficiency, and employee engagement
  • Design and implement claims processing workflows that ensure timely and compliant handling of all group benefit health and dental claims
  • Provide ongoing training and development opportunities for your team to ensure they are equipped with the necessary skills and knowledge
  • Create a client service culture and embed client engagement by inspiring and motivating the claims team to provide the best claims experience in Canada
  • Conduct regular claim file reviews and performance assessments, to identify and evaluate trends to optimize processes and provide recommendations for technology enhancements
  • Identify trends and areas for improvement to enhance claims operations and efficiency
  • Possess excellent communication strategies to handle disputes and escalations, working with claimants and Plan Sponsors to find fair resolutions

Key qualifications include:

  • Minimum 3-5 years experience in group benefits claims management, with a proven record of leading and developing a team
  • Minimum 5-7 years group benefits insurance experience with Health and Dental Claims, with a deep knowledge of claims processing and regulations
  • Bachelor's degree in Human Resources, Business Administration, or equivalent
  • Excellent organizational, analytical, and interpersonal skills, with the ability to manage multiple priorities
  • Strong problem-solving and decision-making abilities, with a focus on providing a client-focused approach
  • Excellent communication skills, with the ability to convey complex information clearly to various stakeholders
  • Proficient in MS Office Suite (e.g., Word, Excel, Outlook, and PowerPoint)
  • Experience working with Customer Service Software
  • An insurance designation is considered an asset (LOMA, CEBS (GBA), ICA, etc.)
  • Bilingualism (French and English) is an asset


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