[Hiring] Bilingual Claims Adjudicator (Insurance) @Recrute Action

Role Description

Build your experience in the insurance industry by supporting the assessment and processing of health and dental claims within a fast-paced transformation project. This fully remote opportunity offers exposure to cloud-based systems, collaboration within a close-knit team, and strong potential for long-term career growth and professional development.

Responsibilities

• Assess complex health and dental claims in accordance with contract provisions and established service standards.
• Review claims for completeness, enter and assess claim information, and determine payment responsibility after insurance benefits are applied.
• Make decisions that may impact member benefit entitlement and payable amounts.
• Manage assigned claims while prioritizing urgent cases effectively.
• Deliver high-quality customer service within established turnaround times.
• Communicate effectively with internal and external stakeholders to meet service expectations and support customer satisfaction.
• Contribute to financial efficiency and continuous improvement objectives.
• Support initiatives aimed at improving customer satisfaction and Net Promoter Score (NPS) results.
• Apply appropriate risk management tools and techniques in daily activities.
• Participate in projects focused on improving claims processing effectiveness and operational efficiency.
• Resolve claims-related issues and coordinate appropriate escalation when required, including claims adjustments and technical decisions.
• Support Business As Usual (BAU) activities during the transition from a legacy system to a cloud-based platform.

Qualifications

• Bachelor’s degree in Business or a related field.
• 0–2 years of professional experience.
• Experience reviewing and adjudicating insurance claims, including verifying policy coverage and determining eligibility for settlement, is an asset.
• Previous experience within the insurance, health care, call center, or data processing industries is an asset.
• Experience collaborating with legal, medical, or external service providers is an asset.
• Strong proficiency with Microsoft Office 365 applications.
• Strong analytical and detail-oriented skills, including the ability to review receipts, extract data, and accurately enter information.
• Excellent verbal and written communication skills for interacting with diverse audiences.
• Ability to work independently and collaboratively in a fast-paced environment.
• Strong customer service orientation and interpersonal skills.
• Ability to take initiative and manage priorities effectively.
• Bilingual in English and French to support communication with internal and external clients while maintaining high-quality customer service standards.

Benefits

• Hourly salary of $19.
• 6-month contract with the potential for permanent employment.
• Full-time position: 37.50 hours per week.
• Schedule from 9 am to 5 pm.
• Enjoy the flexibility of remote work.