This a Full Remote job, the offer is available from: Canada

Bilingual Claims Adjudicator (Insurance)

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.

What is in it for you:

• 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.

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.

What you will need to succeed:

• 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.

Why Recruit Action?

Recruit Action (agency permit: AP-2504511) provides recruitment services through quality support and a personalized approach. As part of the screening process, some applications may be reviewed using artificial intelligence tools. Only candidates who meet the hiring criteria will be contacted.

This offer from "Recruit Action inc." has been enriched by Jobgether.com and got a 72% flex score.