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Claims Adjudicator I

https://www.randstad.com Logo

Randstad

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Location:
Canada , Halifax

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Category:
IT - Administration

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Contract Type:
Not provided

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Salary:

19.79 USD / Hour
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Job Description:

The Claims Adjudicator is accountable for handling claims in accordance with high service standards to meet or exceed client expectations. The Adjudicator is required to make determinations that may affect a member’s entitlement to benefits and/or the amount of benefits payable. The Adjudicator reviews claims for completeness, enters and assesses claims, and produces the final statement and/or payment responsibility after the member’s insurance benefits are applied. Duration: 6-month contract. Remote position. Payrate: $19.79/h.

Job Responsibility:

  • Outline all daily duties, responsibilities, tasks, and accountabilities
  • Assess highly complex health/dental claims in accordance with contract provisions, taking initiative and ensuring empowered decision‑making is a key component of the process
  • Assume ownership of assigned claims, understanding the urgency of specific cases and effectively prioritizing work accordingly
  • Establish and maintain high‑quality customer service within turnaround times, using influence with internal and external clients to meet all pre‑established service standards and delight customers
  • Commitment to financial efficiency and continuous improvement targets, as required
  • Commitment to improving NPS (customer) scores based on overall goals
  • Sound knowledge and ability to apply appropriate risk management tools and techniques
  • Actively participate in projects that improve the effectiveness and efficiency of claims practices in alignment with a culture of continuous improvement
  • Manage all issues and requirements related to claims to achieve customer/claim resolution, handing off only when appropriate (claims adjustments, technical decisions)

Requirements:

  • Claims review and adjudication skills – ability to review insurance claims, verify policy coverage, and determine settlement eligibility
  • Exceptional communication skills – proficient in both verbal and written communication for diverse internal and external audiences
  • Proficiency in Microsoft Office 365 – strong working knowledge of the Office 365 suite of programs
  • Detail‑oriented with quick assessment skills – strong attention to detail required for reviewing receipts, extracting data, and accurately entering information. Analytical skills are essential
  • Team and individual effectiveness – proven ability to work independently and collaboratively in a fast‑paced environment
  • Bachelor’s degree in Business or a related field
  • 0–2 years of overall experience
  • Strong customer service focus
  • Ability to take initiative
  • Excellent interpersonal skills and the ability to interact and work with individuals at all levels to achieve customer satisfaction

Nice to have:

  • Bilingual English/French is an asset
  • Previous claims adjudication and/or relevant insurance or health care industry experience is a strong asset
  • Previous call center and/or data processing experience is an asset
  • Experience collaborating with legal, medical, or external service providers
What we offer:
  • Work-Life Balance
  • Work Model: Full remote
  • Team Culture: Be part of a great team known for its strong sense of community

Additional Information:

Job Posted:
May 18, 2026

Expiration:
July 11, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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