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Randstad Logo Randstad · IT - Administration

Claims Adjudicator I

Canada, Halifax 19.79 USD / Hour · Job Posted May 18, 2026
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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
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