We are professional, agile and challenging.
Our work environment includes:
**Overview:**
We are seeking a skilled Claims Administration Manager to join our team for a temporary maternity leave contract of approximately 22 months. Possibility to extend a permanent position for the right candidate. The ideal candidate will be responsible for overseeing and directing the claims management department and mailroom by ensuring efficient and timely responses for adjudication and administration of multi-employered Trusteed benefit plans.
**Responsibilities:**
- Conducting daily reviews of system related problems and issues that have been escalated by members, then taking effective action to resolve.
- Ensuring the system is up to date for proper benefit adjudication including adjusting dollar values as rates of coverage change (or any benefit improvements).
- With the assistance of a Claims Adjudication Team Lead, manage the turn-around times of adjudication and allocating resources based on workload.
- Sets target metrics for claims adjudicators and addresses any issues related to not meeting these targets.
- Evaluating any monthly reports from insurance carriers, inclusive of unclaimed property lists, terrorist watch lists, delisted clinics, etc.
- Working closely with the Life and Disability advisor, conducting reviews prior to issuing payments for each payment cycle to ensure proper deductions are made on payments according to plan details.
- With the assistance of a Team Lead, overseeing the efficiency of Customer Support (call centre), allocating resources as needed.
- Ensuring all plan accounts are set up and appropriate access permissions are granted to team members.
- Acts as primary escalation point and the main contact when Customer Support Specialists are unable to resolve problems that arise through member emails or phone calls.
- Checking and verifying that the Claims Administrators complete monthly pay directs and "out of benefit" lists.
- Addresses any escalated issues that come from a Union, a member or from Global staff regarding member eligibility.
- Project manages vacation pay cycles and works with accounting to ensure timely and correct payouts to members.
- Providing a monthly "disabled member" report to the Claims Administration system (pay direct rates).
- Supporting the T4 process at tax time by making sure they are assessable to members online and correcting any that are not reflecting accurate information.
**Required Competencies**
- DECISION MAKING: Makes decisions in a timely manner, including under pressure and tight deadlines.
- TRUSTWORTHY: Is widely trusted and is seen as a direct, truthful individual that is counted on by others as a reliable resource and earns the confidence of clients and team members by consistently meeting or exceeding expectations.
- ATTENTION TO DETAIL: Pays close attention to particulars and completes tasks with a high degree of accuracy.
- CONFLICT RESOLUTION: Steps up to conflicts, seeing them as opportunities. Can read situations quickly, focuses on listening and finds common ground and cooperation with minimum noise.
**Mandatory Skills**
- Proficiency using and learning computer applications and strong skills with the Microsoft Office Suite.
- Advanced abilities with Microsoft Office and Excel.
- Efficient and accurate data entry skills.
- Effective communication skills in both written and verbal situations.
- Ability to motivate and direct team members to work independently and as a team.
- Ability to interpret and apply federal and provincial regulations to the claims adjudication and administration process.
**Education & Demonstrated Experience**
- Bachelor's Degree or College Diploma in Business, Administration or related.
- 3-5 years prior experience working in the benefits industry is required.
- 2+ years' experience leading a team.
- Certified Employee Benefits Specialist (CEBS) designation or working towards completion is as asset.
Standard office work conditions (hybrid home/office 3-5 days per week in office).
Job Type: Fixed term contract
Contract length: 22 months (potential for a permanent contract for the right candidate)
Pay: $85,000.00-$97,500.00 per year
Benefits:
Flexible Language Requirement:
Schedule:
Supplemental pay types:
Work Location: Hybrid remote in Etobicoke, ON M9C 5K8
Expected start date: 2024-07-01
