Junior Claims Adjudicator

We are hiring a Junior Claims Adjudicator to join our BPA team in Vaughan. This is a term position ending in March 2027.

The Junior Claims Adjudicator provides timely and accurate adjudication and

reimbursement of benefit claims submitted by members covered under the L.I.U.N.A.

Local 183 Members Benefit Trust Fund. He or she provides courteous and professional

customer service while maintaining departmental standards.

This is a full-time in-office position with hours from Monday to Friday 8 : 30 a.m. to 4 : 30 p.m.

The Junior Claims Adjudicator will :

Responsible for analyzing and adjudicating paper or electronically submitted claims according to contract provisions and maintaining a claims assessment quota of 140 claims per day depending on the claim complexity.

Responsible for evaluating all claims within the 5-day service standard of the Company.

Correspond and communicate via telephone written correspondence or face-to-face with members consultants providers and other internal and external customers.

Apply guidelines determine coverage complete eligibility verification and identify discrepancies.

Verify data entry for accuracy and completeness.

Provide Claims Team Lead with dental claims that need further review to dental consultant.

Data entry of claims sent to dental consultant is added and confirmed on a spreadsheet.

Maintain security and confidentiality of client records.

Other duties as may be assigned from time to time by Management.

To be successful as a Junior Claims Adjudicator with BPA you will need :

Analytical skills to research review and assess claims.

Familiarity with contract wording policy provisions and the Insurance Act.

Compliant with government regulation pertaining to the Privacy Act (PPEIDA).

Strong verbal and written communication skills.

Strong attention to detail with exceptional organization skills.

Ability to manage multiple cases simultaneously.

Intermediate computer skills in the use of related computer applications including Microsoft Word Excel Outlook AS400 CRM Telus and Adjudicare in order to enter and track program data process claims and prepare reports and correspondence.

Participation in company sponsored insurance programs such as FLMI ACS ALHC C.E.B.S. and successful completion of these courses of study during tenure in the position.

Cooperative team player with strong interpersonal skills.

Exceptional customer service skills.

All-star candidates will have :

Proficiency in Portuguese Italian or Spanish will be considered an asset.

Whats in it for you :

Learn by working alongside our experts

Extended health care and dental benefits

A retirement savings plan with company contributions

A suite of Health & Wellness offerings

Mental Health programs and support for you and your family

Assistance for the completion of industry designations

Competitive compensation

BPA is a division of People Corporation and has served members and beneficiaries in their local communities since 1958. BPA is dedicated to providing a superior benefits experience to our members businesses and trusts in the local communities in which they live and operate.

Providing an inclusive accessible environment where all employees and clients feel valued respected and supported is something were committed to. We are dedicated to building a workforce that reflects the diversity of the communities in which we live and to creating an environment where every employeehas the opportunity toreach their potential. If you require an accommodation or an alternative format of any posting please reach out to .

Required Experience :

Junior IC

Key Skills

Clerical,English Language,Administration,Compliance,Investigative reports,SSA,AS400,Critical thinking,CMS,Computer Operating,Mathematics,Medicine,Customer and Personal Service,Personnel Security,Safety and Security

Employment Type : Full-Time

Experience : years

Vacancy : 1