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- Tasks: Adjudicate claims efficiently and assist clients with the member portal.
- Company: Dynamic tech-focused Third Party Administrator based in Kelowna.
- Benefits: Group benefits plan, dental care, wellness program, and paid time off.
- Other info: Full-time role with flexible shift schedules and opportunities for growth.
- Why this job: Join a team that values autonomy and innovation in the health benefits space.
- Qualifications: 3 years of experience in insurance claims adjudication and strong interpersonal skills.
The predicted salary is between 30000 - 40000 £ per year.
We’re a Kelowna based Third Party Administrator/Payor (TPA/TPP) improving the health benefits experience for employers, insurers and, well, everybody! Our team leverages digital-focused strategies to provide members with fast, easy and thoughtful benefits experiences. To put it simply, we provide group benefits plans, but we’re a technology company first. Our team embraces autonomy, complexity and a connection between effort and reward as three qualities that foster a truly satisfying career and strive to separate ourselves from the corporate herd.
What we’re looking for:
We’re looking for a dynamic Group Benefits Adjudicator with a minimum of 3 years’ experience in group benefits claims adjudication. They are responsible for adjudicating claims in a timely and efficient way. They will be knowledgeable enough to walk clients through the member portal, understand plan designs and as well as providing claims processing assistance to the Support team!
What you’ll do:
- The adjudication of claims: collect and review all relevant information to determine legitimacy, eligibility and benefit amount payable.
- Working with the development team and product owners to develop processes and strategies for the efficient and effective adjudication of claims.
- Processing all claims accurately in a timely manner within established service standards.
- Taking ownership and resolving client issues and concerns to the satisfaction of the client and business unit, including but not limited to interacting with customers in Customer Service Capacity.
- Referring questionable/contentious claims for evaluation as needed and providing recommendations for action to help minimize fraud.
- Maintaining and updating all applicable system records.
- Ad hoc duties as required.
What you need:
- Must have a minimum of 3 years in an insurance company claims adjudication role.
- Exceptional interpersonal skills to build positive relationships with our clients.
- Attention to detail and maintaining accurate client files.
- Capable of interpreting and applying claim guidelines while working through ambiguous situations.
- Dedicated team player with the ability to take the initiative, be independent with a positive attitude and dedication to quality and accuracy.
- Highly organized, accurate and detail oriented; well-developed ability to perform complex mathematical calculations.
- Strong organizational skills including the ability to prioritize and multi-task.
- A good understanding of personal computers and software, particularly MS Word, Excel and Outlook.
What we can offer:
- Group Benefits Plan
- In Office Job Type: Full-time, Permanent
- Dental care
- Employee Assistance Program
- Extended health care
- Life insurance
- Paid time off
- Wellness program
Schedule: 8-hour shift– Shift schedule could be anywhere from 8 am to 12pm start time depending on the business need at time of hire.
Group Benefits Adjudicator employer: Simply Benefits Inc.
Contact Detail:
Simply Benefits Inc. Recruiting Team
StudySmarter Expert Advice 🤫
We think this is how you could land Group Benefits Adjudicator
✨Tip Number 1
Network like a pro! Reach out to your connections in the industry, attend local events, and don’t be shy about asking for introductions. We all know that sometimes it’s not just what you know, but who you know that can land you that dream job.
✨Tip Number 2
Prepare for interviews by researching the company and its culture. Understand their values and how they align with yours. When you apply through our website, make sure to highlight how your experience as a Group Benefits Adjudicator fits into their mission of improving health benefits experiences.
✨Tip Number 3
Practice your responses to common interview questions, especially those related to claims adjudication. We recommend using the STAR method (Situation, Task, Action, Result) to structure your answers. This will help you showcase your skills and experience effectively!
✨Tip Number 4
Follow up after your interviews! A simple thank-you email can go a long way in showing your enthusiasm for the role. Plus, it keeps you on their radar. Remember, we’re all about making connections, so let’s keep that conversation going!
We think you need these skills to ace Group Benefits Adjudicator
Some tips for your application 🫡
Tailor Your CV: Make sure your CV highlights your experience in group benefits claims adjudication. We want to see how your skills match what we're looking for, so don’t be shy about showcasing your relevant achievements!
Craft a Compelling Cover Letter: Your cover letter is your chance to shine! Use it to explain why you’re the perfect fit for our team. Share your passion for improving health benefits experiences and how you can contribute to our tech-focused approach.
Show Off Your Interpersonal Skills: Since this role involves building relationships with clients, make sure to highlight your exceptional interpersonal skills in your application. We love candidates who can connect with others and resolve issues effectively!
Apply Through Our Website: We encourage you to apply directly through our website. It’s the best way for us to receive your application and ensures you’re considered for the role. Plus, it shows you’re keen on joining our team!
How to prepare for a job interview at Simply Benefits Inc.
✨Know Your Stuff
Make sure you brush up on your knowledge of group benefits claims adjudication. Familiarise yourself with common claim guidelines and processes, as well as the technology used in the industry. This will help you answer questions confidently and show that you're ready to hit the ground running.
✨Show Off Your Interpersonal Skills
Since this role involves building positive relationships with clients, be prepared to demonstrate your exceptional interpersonal skills. Think of examples from your past experiences where you've successfully resolved client issues or worked collaboratively with a team. This will highlight your ability to connect with others.
✨Be Detail-Oriented
Attention to detail is crucial for a Group Benefits Adjudicator. During the interview, mention specific instances where your attention to detail made a difference in your work. This could be about maintaining accurate client files or ensuring claims are processed correctly. It shows you take pride in your work!
✨Ask Smart Questions
Prepare some thoughtful questions to ask at the end of your interview. Inquire about the company's approach to technology in claims processing or how they support their employees' professional development. This not only shows your interest in the role but also helps you gauge if the company is the right fit for you.