The Claims Adjudicator provides timely and accurate adjudication and reimbursement of benefit claims submitted by members covered under our clients’ Benefit Trust Funds. The Claims Adjudicator provides courteous and professional customer service while maintaining departmental standards. The Claims Adjudicator will: Be responsible for analyzing and adjudicating claims according to contract provisions with the provider agreement up to $2,500. Be 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. Meet monthly production benchmarks, daily and weekly. Assist with coverage at reception. Perform other duties that may be assigned. Key Contacts/Relationships External and Internal: Reports to the Claims Manager and receives work direction from same. Deals directly with Benefit Plan participants/members and their dependents and beneficiaries by phone, fax, email, mail, or in person Corresponds with insurance providers, consultants and Union Representatives with regards to specific claims. To be successful as a Claims Adjudicator with BPA, you will need: Analytical skills to research, review, and assess claims. Strong verbal and written communication skills. Strong attention to detail with exceptional organization skills. The ability to manage multiple cases simultaneously. The ability to learn complexities of multiple benefit packages. Participation in Company sponsored insurance programs such as FLMI, ACS, ALHC and successful completion of these courses of study during tenure in the position. Intermediate computer skills in the use of related computer applications, including Microsoft Word, Excel, Outlook, the administration system (MEBS) and the claims adjudication system (TELUS) in order to enter and track program data, process claims, and prepare reports and correspondence. To be a cooperative team player with strong interpersonal skills. Exceptional customer service skills. 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 we're 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 employee has the opportunity to reach their potential. If you require an accommodation or an alternative format of any posting please reach out to careers@peoplecorporation.com. We know that it's the vast expertise and commitment of our teams in People Corporation and our Partner Firms that have put us where we are today. We value our employees and provide competitive salaries, a comprehensive group benefits plan, and a generous retirement savings plan. And we're in it for the long haul - once you join us, we want you to thrive. If you want to make a difference in the lives of customers, if you take pride in a job well done, and if you like to have fun, talk to us. To learn more about our Partner Firms, please click on the link below. https://www.peoplecorporation.com/en-ca/about-us/our-partner-firms Submit your information for future opportunities. Providing an inclusive, accessible environment, where all employees and clients feel valued, respected and supported is something we're 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 employee has the opportunity to reach their potential. If you require an accommodation or an alternative format of any posting please reach out to careers@peoplecorporation.com. For more information on Accessibility at People Corporation, visit our link https://www.peoplecorporation.com/en-ca/accessibility-statement.
