Medical Claim Adjudication jobs in Ontario

WHO WE ARE

When it comes to health, we’re always looking for ways to push for better. It’s why we were founded in the first place. In 1957, our founder, pharmacist William Wilkinson, witnessed a mother sacrifice her health by forgoing her own medicine to pay for her sick daughter’s prescription. He knew there had to be a better way. So, he introduced North America’s first prepaid drug plan, and GreenShield was born as a non-profit with a mission to support better health for all Canadians.

We aren’t just a health and benefits company. We’re the only non-profit social enterprise that brings worlds of coverage and care together, all in one place.
We’re noble challengers, purposefully building a better way and we need the best people to help us create a more holistic approach that takes care of the mind and body.

Our mission is to create better health for all Canadians, and we know that starts with our employees.

THE ROLE IN A NUTSHELL

Base Salary: CAD $38,774.00 - 53,699.00

GreenShield is seeking a Pharmacy Coordinator (known internally as Pharmacy Assistant) who is passionate about helping people, communicating clearly, and taking ownership of administrative and coordination tasks that directly impact patient care.

This role places a strong emphasis on prescription billing/processing, patient communication, documentation, coordination, and problem-solving. While pharmacy or healthcare experience is valuable, we are intentionally prioritizing mindset, motivation, and soft skills over technical background. We are looking for someone who is curious, resilient, organized, and excited to grow their career within GreenShield—not just within pharmacy operations.

The successful candidate will be supported through training and onboarding, with technical skills learned on the job. What matters most is your ability to communicate effectively, manage details, and consistently show up for patients and teammates.

Key Responsibilities

Patient Communication & Experience

• Act as a key point of contact for patients via phone and email, providing clear, empathetic, and professional communication.
• Support patients by answering routine questions related to prescriptions, refills, deliveries, coverage, and documentation, escalating clinical concerns to the pharmacist when appropriate.
• Proactively follow up with patients to gather required information, confirm next steps, and ensure continuity of care.
• Build trust with patients by explaining processes clearly and helping them navigate complex or time sensitive situations.
• Contribute to a positive, respectful, and inclusive patient experience aligned with GreenShield values.

Administrative & Documentation Support

• Accurately enter, update, and maintain patient and prescription information within pharmacy systems (e.g., Kroll).
• Prepare and process prescriptions, including insurance claims, billing documentation, and third-party reimbursement and appropriate paperwork.
• Identify and resolve billing or adjudication issues by coordinating with payers, prescribers, patient support programs, and internal teams.
• Ensure copayments are processed accurately and documentation meets regulatory and internal standards.
• Maintain organized, audit ready records with strong attention to detail.

Coordination & Workflow Management

• Complete assigned tasks, billing, and trouble shooting orders according to GreenShield Pharmacy standard operating procedures and performance guidelines
• Assist with scheduling prescription refills and coordinating medication deliveries to support uninterrupted patient therapy.
• Work closely with pharmacists, nurses, clinics, physicians, and external partners to obtain required information and resolve issues.
• Anticipate potential delays or gaps and take ownership of resolving them before they impact patients.
• Take on additional responsibilities or projects as needed and assigned by the Manager, demonstrating flexibility and accountability.

WHO WE'RE LOOKING FOR

• High school diploma or equivalent required.
• Strong communication skills and comfort speaking with patients, providers, and internal partners.
• A patient first mindset with genuine care for helping others navigate healthcare.
• High attention to detail and pride in getting things right.
• Resilience and persistence when working through complex or ambiguous situations.
• Curiosity, motivation, and a desire to learn and grow within GreenShield.
• Ability to manage multiple priorities in a fast paced, protocol‑driven environment.

Nice-to-have

• Experience in pharmacy, healthcare, administration, retail, hospitality, call centres, or other high service environments is welcome.
• Previous exposure to pharmacy systems (e.g., Kroll), billing, claims, or medical administration is an asset, but not required.
• Experience working in structured, high-pressure, or customer‑focused environments (e.g., retail, hospitality, healthcare, tourism) is highly va

THE CULTURE

We believe a career should be meaningful. Not just a means to earn a living. Our culture is one where everyone's voice is heard and valued. Because that’s what it takes to create better health for all. We dare to challenge the status quo. And we’re driven by people who have challenged theirs. We believe that your workplace should empower you to be the best version of yourself. That’s why we provide a place where you can be inspired, challenged, and rewarded.

Where your growth means our growth.
Where your voice is heard and valued.
Where your work has purpose. And purpose matters.

We believe our people are critical to our overall success. Inclusivity makes us a stronger, smarter and more informed organization. Being intentionally inclusive of diverse backgrounds, perspectives and experiences will enhance our company culture to positively impact how we support our communities. A career at GreenShield isn’t just about personal achievements, it's about making a difference together.

Here’s to Better Health for All!

A FEW MORE DETAILS

Proficiency in English is required for this position. As part of this role, you will be required to communicate with colleagues or customers who use English as their primary language. By requiring English proficiency for this position, we aim to ensure that our employees can excel in their roles, collaborate, and communicate effectively, and contribute to the success of our organization.

GS supports diversity, equity and inclusion in our teams and communities, and we value the unique contributions made by all. Even if your experience doesn’t align perfectly to every requirement, we invite you to apply. We encourage applications from all candidates and will accommodate needs under human rights legislation throughout all stages of the recruitment and selection process. Please let us know of any accommodation through requestforaccommodation@greenshield.ca. Information received relating to accommodation will be addressed confidentially.

Providing this information gives GS consent to use your personal information to assess your suitability for specific positions, future opportunities or for your personnel file. Your résumé will be held in strict confidence and will be viewed only by the Organization. Information may be stored outside of Canada and could be used for aggregate statistical purposes (which uses no personal identification).

AI Usage - GreenShield leverages AI to help produce Job Descriptions, and ideate on interview questions. We also leverage AI for interview transcription support.