Who are we

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 Advantages 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 Group Benefits Adjudicator role is responsible for but not limited to the following:

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 valuable understanding of personal computers and software, particularly MS Word, Excel and Outlook.

What we can offer

Group Benefits Plan

Growth Opportunities In Office

Competitive Salary

Job Type: Full-time, Permanent

Benefits

Casual dress

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.

Monday to Friday

No weekends

Location

Ayr Ontario

Pay: $53,000.00-$55,000.00 per year

📌 Group Benefits Adjudicator (Ayr)
🏢 Simply Benefits
📍 Ayr