What We Offer- Vacation and Earned Time Off program
- Group Retirement Savings Plan with employer match
- Employee benefits plus Health & Wellness Spending Account
- Educational assistance and career development
- One-hour early finish on Fridays
- Employee Assistance Program and employee discount programs
- On-site gym
- 5% bilingualism premium for qualified professional-level French bilingualism, where applicable
Why This Opportunity is DifferentDon't just lead the function. Help build it.This isn't a role where you'll simply inherit an established playbook and manage against it.
You'll lead people and operations, but you'll also have the opportunity to influence how the function evolves - including processes, workflows, technology, service delivery, team capability and client experience.
You'll work directly with the Vice President, Claims & Administration and the President of Group Benefits, bringing your expertise into discussions about both today's operation and tomorrow's business.
We're looking for a leader who is equally comfortable coaching an employee, digging into an operational issue and stepping back to determine what needs to change strategically.
What You'll Build- How our growing Claims function is structured and operates.
- Claims processes, workflows, quality standards and service delivery.
- Development and implementation of our Claims platform.
- Team structure, capability, coaching and future development.
- Who we hire as the Claims team grows: role design, selection and building the right mix of experience.
- How we train and onboard new examiners, including the knowledge, tools and standards they need to adjudicate confidently.
- Operational measures and practices that support quality, productivity and client experience.
- Capacity planning and service levels: how we forecast claim volumes, staff to them and hold turnaround commitments as we grow.
- Quality, privacy and compliance controls: how we protect member health information and keep adjudication decisions consistent and defensible.
- How Claims works with Administration, Technology and other areas of Group Benefits.
- Future Claims capabilities and priorities as the business continues to grow.
- Division direction beyond your own function: you'll take part in leadership and strategic planning sessions alongside the President, Vice President, Directors and fellow Managers.
Growth creates opportunityAs our business has grown, employees have had opportunities to expand their responsibilities and move into leadership positions. We're continuing to build the capabilities and leadership structure our future business will require.
Where you'll workOur Group Benefits team works together in-office in Edmonton. We believe the stage we're at as a growing business benefits from close collaboration, immediate access to leaders and the ability to solve problems together.
What you'll doEssential Responsibilities:- Recruit, onboard and develop a high-performing health and dental claims adjudication team; set clear expectations and cultivate a culture of accuracy, accountability and continuous learning.
- Design and implement claims processing workflows that ensure every claim is handled correctly, compliantly and efficiently from submission through payment or denial.
- Partner in the evaluation and selection of a new claims adjudication software platform; provide ongoing input to system development and enhancement.
- Conduct regular claim file audits and performance reviews; identify trends, flag emerging risks and turn data into process improvements.
- Serve as the escalation point for complex or disputed claims by communicating clearly with claimants and Plan Sponsors to reach fair, well-reasoned resolutions.
- Provide ongoing training so your team stays current on products, regulatory requirements and evolving best practices.
- Collaborate with the administration team and senior leadership to align claims operations with broader business objectives.
- Track and report on claims KPIs; use metrics to drive performance and surface opportunities for improvement.
- Other duties as assigned.
Qualifications:- 5-7+ years of hands-on group benefits health and dental claims adjudication experience, with deep knowledge of claims regulations and processing standards.
- 1-3+ years in a leadership role overseeing a claims adjudication team.
- A track record of building or transforming claims operations - process design, workflow optimization, or technology implementation experience is a strong plus.
- Bachelor's degree in Business Administration, Human Resources or equivalent.
- Strong analytical and organizational skills; able to manage multiple priorities without losing attention to detail.
- Clear, confident communicator - skilled at navigating difficult conversations with claimants and stakeholders alike.
- Proficient in Microsoft Office Suite; familiarity with claims adjudication software is an asset.
- 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.
