Claims Adjudicator
Claims Adjudicator
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Job Description
We are seeking a term Junior Claims Adjudicator (Term) to join our BPA team in Vaughan. This is a 12-month fixed term.
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 Members 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 1pm 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 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.
Apply guidelines determine coverage complete eligibility verification and identify discrepancies.
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.
Deals directly with Benefit Plan participants/members their dependents and beneficiaries by phone fax email mail or in person.
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 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.
Intermediate computer skills in the use of related computer applications including Microsoft Word Excel Outlook AS400 CRM Telus and Adjudicare 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.
All-star candidates will have:
Previous experience in the group benefits industry
Whats in it for you:
Learn by working alongside our experts
Extended health care anddentalbenefits
Aretirementsavings 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.
Providing an inclusive accessible environment where all employees and clients feel valued respected and supported is something were committed to. We are dedicated to building a workforce that reflects the diversity of the communities in which we live and to creating an environment where every employeehas the opportunity toreach their potential. If you require an accommodation or an alternative format of any posting please reach out to .
Employment Type
Full-Time
