Junior Claims Adjudicator (Term)

Junior Claims Adjudicator (Term Position – ending February 7, 2027)

We are hiring a Junior Claims Adjudicator to join our BPA team in Vaughan. This is a full‑time, in‑office position with hours from Monday to Friday, 8:30a.m. to 4:30p.m.

Key Responsibilities

• Analyze and adjudicate paper or electronically submitted claims in accordance with contract provisions.
• Maintain a claims assessment quota of 140 claims per day, depending on claim complexity.
• Evaluate all claims within the 5‑day service standard of the Company.
• Correspond with members, consultants, providers, and internal/external customers by telephone, written correspondence, or face‑to‑face.
• Apply guidelines, determine coverage, complete eligibility verification, and identify discrepancies.
• Verify data entry for accuracy and completeness.
• Provide dental claims that require further review to the dental consultant and manage data entry on a ...