- Responsible for analyzing and adjudicating paper or electronically submitted claims, according to contract provisions and maintaining a claims assessment quota of 140 claims per day, depending on the claim complexity.
- 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.
- 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.
- 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 Adjudicate 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.
- 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
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Intermediate Claims Adjudicator - Vaughan, Canada - People Corporation
Description
Job Description
We are seeking a Intermediate Claims Adjudicator to join our BPA team in North York.
The Intermediate 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.
Please note that the office location is currently Toronto (1263 Wilson Ave.); however, the office will be relocating to Vaughan (Langstaff Rd. & Highway 50) in the coming months.
The Intermediate Claims Adjudicator will:
To be successful as a Intermediate Claims Adjudicator with BPA, you will need:
What's in it for you:
At People Corporation we are committed to helping businesses succeed. We are a national provider of benefits, retirement, wealth, wellness, and human resource solutions. Our experts and solutions serve over 20,000 clients representing nearly 3 million Canadians. We offer customized solutions designed to fit the unique needs of businesses and their employees, members and stakeholders.
About BPA:
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 we're 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 employee has the opportunity to reach their potential.
