5-7+ years in group health and dental claims adjudication with strong regulatory knowledge.
3-5 years leadership experience in building high-performing teams.
Experience in designing or improving operational workflows in claims administration.
Bachelor's degree in Business Administration, Human Resources, or related field, or equivalent experience.
Strong organizational and analytical skills for managing fast-paced priorities.
Excellent communication skills for simplifying complex information.
Proficient in Microsoft Office Suite; experience with claims administration software preferred.
Insurance designation (LOMA, CEBS/GBA, ICA) is a valuable asset.
Bilingual English/French is advantageous.
Responsibilities
Lead recruitment, onboarding, coaching, and management of claims teams.
Design and refine workflows for health and dental claims processing and plan administration.
Develop scalable best-practice solutions for a growing client base using industry expertise.
Champion system enhancements for claims adjudication and administration platforms.
Conduct regular claims reviews; translate findings into process and tech improvements.
Foster a client service culture and handle escalations professionally and efficiently.
Provide ongoing training to keep teams informed and confident.
Report operational KPIs to leadership and utilize data for continuous improvement.
Benefits
Opportunities for professional development and ongoing training.
Supportive company culture emphasizing client service and team success.
Access to advanced technology platforms and resources for claims processing.
Full Job Description
What you\'ll do
Essential Responsibilities:
Lead the build-out of both the claims adjudication and plan administration teams, from recruitment and onboarding through to ongoing coaching and performance management.
Design, implement and continuously refine end-to-end workflows for health and dental claims processing and group plan administration, ensuring accuracy, timeliness and regulatory compliance.
Leverage your deep industry knowledge to develop best-practice solutions that scale with our growing client base.
Champion the selection and ongoing development of our claims adjudication and administration technology platforms, serving as a key stakeholder in system enhancements.
Conduct regular claims file reviews and performance assessments; translate trends into actionable process improvements and technology recommendations.
Build and sustain a client service culture that puts members and Plan Sponsors first - handle escalations with professionalism and resolve disputes with fairness and speed.
Provide ongoing training and development to ensure your teams are always equipped with current knowledge, tools and confidence.
Report on operational KPIs to senior leadership and use data to drive continuous improvement.
Other duties as assigned.
Qualifications:
5-7+ years of experience in group benefits health and dental claims adjudication, with a thorough command of claims processing practices and relevant regulations.
3-5 years in a people leadership role, with demonstrated success building and leading high-performing teams.
Proven experience designing or overhauling operational workflows in a claims or administration environment.
Bachelor\'s degree in Business Administration, Human Resources or a related discipline (or equivalent experience).
Exceptional organizational and analytical skills; comfortable managing competing priorities in a fast-moving environment.
Outstanding written and verbal communication skills; able to translate complexity for diverse audiences.
Proficient in Microsoft Office Suite; experience with claims or benefits administration software strongly preferred.
Insurance designation (LOMA, CEBS/GBA, ICA) is a significant asset.
Bilingual English/French is an asset.
Successful completion of pre-employment screening (criminal, credit, education, reference and designation verification) is required.
