Manager, Claims and Administration
Core
Overseeing the Claims Management department, ensuring benefit adjudication systems function correctly, and directing the resolution of member inquiries and escalated issues.
Role type
Manager, Claims and Administration
Builds
Benefit adjudication processes, member card setups, payment cycles, and compliance reporting for health and welfare plans.
Domain
Employee Benefits Administration
Deliverable
client delivery
Required skills
Team leadership and recruitment, claims adjudication oversight, system configuration and rate management, call centre operations management, financial payment processing, regulatory compliance, data analysis
Preferred skills
Certified Employee Benefits Specialist (CEBS) designation
Technologies
Microsoft Office (Word, Excel), 3rd party TPP systems
Responsibilities
Conduct daily reviews of escalated system issues and resolve them; manage turnaround times and resource allocation for claims; oversee call centre efficiencies and schedule coverage; sign off on payment cycles and cheque/EFT approvals; recruit and develop team members; ensure adherence to regulatory requirements.
Seniority
Manager, hands-on leadership