Accident and Health Claims Adjudicator - Level 2

Join our team as an Accident & Health Claims Adjudicator and play an important role in helping people through the claims process with care, accuracy, and professionalism. In this role, you will review and assess accident an health insurance claims, interpret policy coverage, and make fair, timely decisions based on the information provided. You'll work closely with claimants, healthcare providers, brokers and internal partners to gather information, answer questions, and ensure each claim is handled with empathy and attention to detail.

This is a great opportunity for someone who enjoys problem-solving and making a meaningul impact by supporting customers when they need it most.

The annual salary range for this role is $54,000 to $82,000.

• Assess low-complexity Affinity claims (travel, baggage, simple reimbursements).
• Determine benefit entitlement according to policy and claims handling processes.
• Collect and analyze additional data (e.g., medical information).
• Resolve inquiries promptly and maintain client/referral relations.
• Make timely first contact on new claims and gather additional information to expedite decisions.
• Prepare verbal and written reports supporting decisions.
• Record detailed progress notes and prepare correspondence using approved templates.
• Ensure accurate eligibility determination and adherence to turnaround timelines.
• Maintain reserves, obtain necessary authority, and process payments promptly.
• Submit accurate billing and expense reports on time.
• Provide timely responses to claimants and stakeholders.
• Document all communications in the system.

• Minimum 3-5 years Accident and Health Adjudication experience
• Experience in disability, critical illness and life benefits
• Full Provincial Adjusting License or CIP designation is required
• Post Secondary education in an insurance related field considered an asset
• Experience in adjusting including the investigation and detailed reporting of multi-line claims
• Excellent ability to interact with clients, claimants, and field staff for the exchange of information often requiring analysis
• Excellent interpersonal abilities are required to enable effective interaction and communication in both oral and written format with employees, policyholders, employers and other insurance/medical/legal professionals
• The ability and willingness to learn multiple computer systems
• Strong analytical and decision making skills
• Ability to multi task
• Ability to effectively manage change
• Strong computer and reporting skills including Office 360 and Windows10
• Must be a team player with outstanding customer service skills
• Willingness to work in a dynamic environment with opportunity for career growth

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