Claims Adjudicator I

The Claims Adjudicator is accountable for handling claims in accordance with high service standards to meet or exceed client expectations. The Adjudicator is required to make determinations that may affect a member’s entitlement to benefits and/or the amount of benefits payable. The Adjudicator reviews claims for completeness, enters and assesses claims, and produces the final statement and/or payment responsibility after the member’s insurance benefits are applied.

Duration: 6-month contract

Remote position

Payrate: $19.79/h


Advantages
Work-Life Balance

Work Model: Full remote

Team Culture: Be part of a great team known for its strong sense of community.

Responsibilities
• Outline all daily duties, responsibilities, tasks, and accountabilities
• Assess highly complex health/dental claims in accordance with contract provisions, taking initiative and ensuring empowered decision‑making is a key component of the process.
• Assume ownership of assigned claims, understanding the urgency of specific cases and effectively prioritizing work accordingly.
• Establish and maintain high‑quality customer service within turnaround times, using influence with internal and external clients to meet all pre‑established service standards and delight customers.
• Commitment to financial efficiency and continuous improvement targets, as required.
• Commitment to improving NPS (customer) scores based on overall goals.

Supporting the Business:
• Sound knowledge and ability to apply appropriate risk management tools and techniques.
• Actively participate in projects that improve the effectiveness and efficiency of claims practices in alignment with a culture of continuous improvement.
• Manage all issues and requirements related to claims to achieve customer/claim resolution, handing off only when appropriate (claims adjustments, technical decisions).

Qualifications
MUST‑HAVE Hard Skills:
• Claims review and adjudication skills – ability to review insurance claims, verify policy coverage, and determine settlement eligibility.
• Exceptional communication skills – proficient in both verbal and written communication for diverse internal and external audiences.
2) Proficiency in Microsoft Office 365 – strong working knowledge of the Office 365 suite of programs.
3) Detail‑oriented with quick assessment skills – strong attention to detail required for reviewing receipts, extracting data, and accurately entering information. Analytical skills are essential.
4) Team and individual effectiveness – proven ability to work independently and collaboratively in a fast‑paced environment.

Degree/Certifications Required: Bachelor’s degree in Business or a related field.
Years of Overall Experience: 0–2

SOFT SKILLS:
• Strong customer service focus
• Ability to take initiative
• Excellent interpersonal skills and the ability to interact and work with individuals at all levels to achieve customer satisfaction

NICE‑TO‑HAVE:

Bilingual English/French is an asset
Previous claims adjudication and/or relevant insurance or health care industry experience is a strong asset
Previous call center and/or data processing experience is an asset
Experience collaborating with legal, medical, or external service providers


Summary
To Apply: If you are a professional looking to join a dynamic team, please apply directly with your resume to be considered for this opportunity.

Randstad Canada is committed to fostering a workforce reflective of all peoples of Canada. As a result, we are committed to developing and implementing strategies to increase the equity, diversity and inclusion within the workplace by examining our internal policies, practices, and systems throughout the entire lifecycle of our workforce, including its recruitment, retention and advancement for all employees. In addition to our deep commitment to respecting human rights, we are dedicated to positive actions to affect change to ensure everyone has full participation in the workforce free from any barriers, systemic or otherwise, especially equity-seeking groups who are usually underrepresented in Canada's workforce, including those who identify as women or non-binary/gender non-conforming; Indigenous or Aboriginal Peoples; persons with disabilities (visible or invisible) and; members of visible minorities, racialized groups and the LGBTQ2+ community.

Randstad Canada is committed to creating and maintaining an inclusive and accessible workplace for all its candidates and employees by supporting their accessibility and accommodation needs throughout the employment lifecycle. We ask that all job applications please identify any accommodation requirements by sending an email to accessibility@randstad.ca to ensure their ability to fully participate in the interview process.