Junior Claims Adjudicator and Client Care
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Job Location:
Monthly Salary:
Posted on:
5 hours ago
Vacancies:
1 Vacancy
Job Summary
About EIO:
At EIO we help small businesses deliver better employee benefits and workplace experiencessupporting employee well-being while enabling employers to attract and retain top talent. Our approach is practical and data-driven grounded in what we call Employee Investment Optimization.
As part of our fully remote team youll enjoy flexibility competitive compensation and benefits and opportunities for professional growth within a collaborative and high-performing environment. Were proud of the culture weve built and are entering an exciting phase of growth. If youre thoughtful motivated and interested in contributing to meaningful work EIO offers a place to build and grow your career. Join us and be part of whats next.
About the Position:
We are seeking a Bilingual Health and Dental Claims Adjudication & Customer Service Representative to support our TPA operations and member service this role you will be the heartbeat of our health and dental claims processing ensuring that member inquiries are resolved quickly and adjudications are handled with precision. Working closely with our insurance carriers and partners youll help maintain our high standards of service in a fully remote fast-paced environment.
In this role youll be:
- Executing daily claims adjudication and providing direct support to our members.
- Managing member inquiries and tickets using HubSpot Helpdesk.
- Following and refining internal SOPs to ensure seamless benefits administration.
- Coordinating with insurance carriers and TELUS claims partners to resolve routine processing issues.
Who This Role Is Perfect For
This role is ideal for a detail-oriented professional with a foundation in group benefits who loves helping people and solving puzzles. You might currently be a claims assistant or a customer service representative in the insurance space looking to specialize in TPA operations.
Youll do well in this role if you:
- Take immense pride in accuracy and delivering a wow experience for members.
- Are a problem-solver who enjoys digging into plan documents to find answers.
- Thrive in a hands-on environment where you manage your own desk and priorities.
- Communicate clearly and empathetically in both French and English.
- Want a remote role where you can grow your technical knowledge of Canadian benefits.
What Youll Be Doing
- Process & Adjudicate: Handle daily health and dental claims processing ensuring accuracy and alignment with specific plan documents.
- Member Support: Act as the first point of contact for member inquiries via HubSpot resolving tickets related to coverage and claims.
- Carrier Liaison: Coordinate with insurance carriers and TELUS Adjudicare to troubleshoot submission errors or eligibility issues.
- SOP Documentation: Assist in documenting and updating internal workflows to keep our operations running smoothly.
- Data Accuracy: Support group setup plan member onboarding and data entry within our administration systems.
- Bilingual Service: Provide high-quality support in both French and English for a diverse member base.
- Compliance: Maintain strict adherence to privacy and regulatory requirements (PHIPA / PIPEDA).
Must-Have Skills & Experience
- Bilingualism: Fluency in French and English (written and verbal) is required.
- Experience: 13 years in claims adjudication benefits administration or a TPA/insurance environment.
- Technical Savvy: Experience with TELUS Adjudicare is a very strong asset; comfort using HubSpot or similar ticketing systems is preferred.
- Knowledge Base: A solid understanding of Canadian extended health and dental plans (Life AD&D Health Dental HCSA).
- Detail Oriented: Ability to interpret plan designs and assist with the creation of complex benefit booklets and ASO/HSA plan structures.
- Self-Starter: Proven ability to work independently and stay organized in a fully remote setting.
Why Youll Love Working With Us
- Fully Remote: Work from anywhere in Canada.
- Growth Potential: Gain deep technical expertise in a growing organization.
- Impact: Your work directly helps members navigate their health and wellness benefits.
- Modern Tools: Work with a tech-forward stack (HubSpot TELUS Slack) instead of legacy systems.
Required Experience:
Junior IC
About Company
Give more to your employees-better benefits, working experiences, and even wages- by finding smarter ways to invest. EIO Advisors can show you how.
