Health Claims Assessor

• Manage and assess a variety of Health and Dental claims, including Travel and CostPlus accounts, submitted through multiple channels, including traditional paper mail and electronic (web/mobile) portals.
• Review claim documents, applying policies, procedures, and contract terms to ensure accurate and consistent results.
• Proactively develop a foundational understanding of Group Benefits (Dental, Health, and Drug) and learn how to ensure proper adjudication.
• Evaluate claims for appropriate integration with provincial programs (e.g., Fair Pharmacare, Trillium, RAMQ) to ensure accurate first-payer processing.
• Manage a high daily volume of claims while adhering to strict quality and accuracy benchmarks.
• Independently manage a personal daily workload, balancing multiple tasks to meet departmental service level agreements (SLAs).
• Identify suspicious claim patterns or potential irregularities (fraud/abuse) and follow established protocols to transfer these files for more detailed technical or investigative review.
• Interact and communicate with internal and external customers through various channels on plan design restrictions, claim eligibility, and claim outcomes.
• Provide proactive, prompt, and professional resolution of claim inquiries from both internal and external customers to minimize any escalations.
• Foster a positive team environment through active collaboration, sharing knowledge with peers, and demonstrating the empathy and active listening required to handle sensitive member information.

What we’re looking for you to have

• 1–3 years of experience in an office environment, preferably in a healthcare setting.
• Previous experience in a medical, dental, or insurance environment is an asset.
• Eagerness to learn Group Benefits (Health, Dental, Drug).
• Proficient in Microsoft Office (Excel/Outlook) and quick to learn internal claims systems.
• Designation as a Certified Dental Assistant is an asset.
• High attention to detail with strong alphanumeric processing skills.
• Clear verbal and written skills for handling routine claim inquiries.
• Ability to work effectively within a team and support peers during peak volumes.
• Ability to prioritize and balance multiple tasks.
• If you are applying for a position which is open to applicants across Canada, unless otherwise indicated in the position, language proficiency in English is required for communicating with customers, advisors, or employees across Canada.
• Our hiring process includes AI screening for keywords and minimum qualifications. Recruiters review all results.

Beyond the salary

• Hybrid work model
• Competitive salaries with annual pay increases
• Annual bonus program, which recognizes both strong company performance and individual contributions, for non sales positions
• Access to learning & development programs, and education/tuition reimbursement (role dependent), to support your professional growth and career advancement.
• Competitive uncapped commission, for sales positions
• A comprehensive employer-funded benefits package starting from day one of employment, that includes life insurance, health and dental and a generous health account
• Flexible work arrangements and an annual allotment of personal health days.
• Four weeks annual vacation from hire date
• A defined contribution pension plan with generous employer matching
• Top up programs for parental leave and compassionate leave
• Employer-sponsored wellness and recognition programs

• A cash employee referral program

To learn more about working at Empire Life, visit https://www.empire.ca/workatempire.

Get to know us

Empire life is proud to be an equal opportunity employer. We celebrate diversity, are committed to creating an inclusive environment, and welcome everyone to participate in our application process. We encourage those of all backgrounds and experiences to apply, even if you don't believe you meet each unique qualification outlined. Applicants will receive equal consideration without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, disability, or age.