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Junior Claims Adjudicator

2 weeks ago

Vaughan, Canada Benefit Plan Administrators Services Limited Full time

We are seeking a Junior Claims Adjudicator (Term) to join our BPA team in Vaughan.

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.

This position is 100% in-office.

Working Hours:
Monday to Friday 8:30 am - 4:30 pm
Special working condition: rotating shift schedule for Wednesday 12pm to 8pm and Saturday 7am to 12:30pm.

Over time, may be required should the claims turnaround exceed the 5 day Company Standard.
**The Junior Claims Adjudicator (Term) will**:

- 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.

Key Contacts/Relationships External and Internal:
- 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 Junior Claims Adjudicator (Term) with BPA, you will need**:

- Fluency in English as well as at least one of Portuguese, Spanish or Italian preferred.
- 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.
- 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.
- Previous experience in the group benefits industry

**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

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.