Bilingual Claims Adjudicator
New
CanadaContractEntry
Salary not disclosed
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Job Details
- Languages
- English, French
- Experience
- 0–2 years
- Required Skills
- Analytical SkillsCustomer serviceData entry
Requirements
- Bachelor’s degree in Business or a related field
- 0–2 years of experience in insurance, healthcare, call center, or data processing environments (asset)
- Exposure to claims adjudication, eligibility verification, or benefits administration is an advantage
- Strong bilingual proficiency in English and French (mandatory)
- High attention to detail with strong data entry and analytical capabilities
- Proficiency in Microsoft Office 365 applications
- Strong customer service mindset and ability to communicate clearly with diverse stakeholders
- Ability to work independently while also contributing effectively in a team setting
- Strong time management, prioritization, and adaptability in a dynamic workload environment
Responsibilities
- Assess and adjudicate health and dental claims in line with policy provisions and service standards
- Review claim submissions for completeness, verify eligibility, and determine payable amounts
- Enter and process claim data accurately within internal systems
- Manage assigned claims queues, prioritizing urgent and complex cases appropriately
- Communicate with internal teams, members, and external stakeholders to resolve inquiries and ensure service quality
- Support risk management practices and contribute to operational accuracy and financial efficiency
- Participate in system transition initiatives and continuous improvement projects
- Escalate and resolve claims issues, including adjustments and technical decision support when required
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