Senior Claims Assessor

People Corporation

. Adjudicate and process member claims in accordance with established policies and procedures .

Posted 10/6/2026full-timeWinnipeg • CanadaSenior💰 CA$50,000 - CA$53,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in claims adjudication and benefits administration, with strong leadership capabilities to mentor and guide team members. Proficient in processing claims, verifying eligibility, and maintaining compliance with policies and procedures.

Highest-signal resume keywords

Claims AdjudicationBenefits AdministrationLeadership AbilitiesMicrosoft Office SuiteBilingual Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingData EntryMathematical SkillsMedical TerminologyDental TerminologyElectronic Claims ProcessingPolicy InterpretationCost-Plus Plans AdministrationForeign Currency ConversionClaims Payment Calculation

Soft Skills

Communication SkillsOrganizational SkillsAttention to DetailTact and DiscretionMentoring

Certifications & Qualifications

CEBSLOMAICA

Industry Keywords

Health ClaimsDental ClaimsGroup BenefitsIndividual BenefitsClaims SystemClient InquiriesPerformance EvaluationsWorkflow CoordinationQuality ImprovementsAd Hoc Reports

About the role

Key responsibilities & impact

Adjudicate and process member claims in accordance with established policies and procedures
Respond to inquiries regarding claims and benefits
Provide mentorship and guidance to team members
Act as a back-up to other senior positions in the Claims Department
Process paperless and traditional claims using the claims system and identify missing information
Administer Cost-Plus Plans or Health Care Spending Accounts and prepare ad hoc reports for the Consulting department
Produce claims payments and apply applicable deductibles
Calculate conversion of Canadian funds into foreign funds
Verify member eligibility, drugs, services, providers, co-insurance, deductibles, payments, and procedure/dental codes
Review previous submissions and group contracts/policies
Review and verify cheques, correspondence, forms, addresses, and reports
Investigate complaints, overpayments, and underpayments, and take corrective action
Interpret policies and administrative practices and apply them in claims adjudication
Perform claims-related data entry and prepare correspondence for members, carriers, or clients
Respond promptly and courteously to clients, members, and external contacts
Provide information and assistance concerning coverage, claims processing and payment, and benefits parameters
Review and audit Claims Assessors' work for internal audit requirements
Guide and train new staff on the claims system, department policies and procedures, and customer service
Mentor and support staff while resolving discrepancies and recommending productivity and quality improvements

Requirements

What you’ll need

Completion of post-secondary education in a related field
Minimum 3+ years of work related experience in health and dental claims adjudication or benefits administration
Sound knowledge of medical and dental terminology in the concept of group or individual benefits administration
Strong leadership abilities, including coordinating workflow, training subordinates, motivating a team and individual performance, and assisting in performance evaluations
Strong working proficiency with the Microsoft Office Suite and standard office administration procedures
Demonstrated ability to learn and master new software and technology
Excellent grammatical, spelling, and communication skills
Strong mathematical skills and attention to detail
Excellent organizational skills, with the ability to prioritize and manage time effectively
Ability to use tact and discretion to maintain information in the strictest of confidence
Training in industry related courses provided by CEBS, LOMA, or the ICA is an asset
Bilingual proficiency in both English and French is an asset
Experience processing electronic claims is an asset

Benefits

Comp & perks

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
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