Director, Group Claims & Administration
- Edmonton, AB, Canada
Full-time
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Job details
- Job type
- Full-time
- Apply by
- Experience
- 5-7+ years of experience in group benefits health and dental claims adjudication, with a thorough command of claims processing practices and relevant regulations.
- Posting language
- English
- Posted
Original job description
Bring What You Know. Help Build What's Next.
First Canadian Group Benefits is growing nationally, and we're investing in the people, technology and capabilities that will support our next stage of growth.
A division of an established Canadian financial services organization, we have the stability and resources behind us to build for the future while remaining small enough that talented people can have a meaningful influence on where we're going.
Our employees work directly with senior Group Benefits leaders, including our President and Vice President. Ideas move quickly, expertise is valued and you'll have the opportunity to see the impact of your work.
We're looking for people who want more than a narrowly defined role. People who can get into the details, solve problems and understand the operation while also stepping back, thinking strategically and asking how we can make it better.
If you've built your Group Benefits expertise and are ready to use it to help build what's next, this could be the opportunity you've been looking for.
What We Offer
A seat close to the decision table and the authority to influence it.
You won't be several layers removed from the people determining the direction of the business.
You'll work directly with senior Group Benefits leadership and will have meaningful latitude to evaluate how your function operates, recommend changes, build capability and influence the future direction of the division.
What You’ll Shape
As our business has grown, employees have had opportunities to expand their responsibilities and move into leadership positions. We're continuing to build the capabilities and leadership structure our future business will require.
Where you'll work
Our Group Benefits team works together in-office in Edmonton. We believe the stage we're at as a growing business benefits from close collaboration, immediate access to leaders and the ability to solve problems together.
What You'll Do
Essential Responsibilities:
Thank you for considering our organization.
We are an equal opportunities employer and welcome applications from all suitably qualified persons. Accommodations are available upon request.
First Canadian Group Benefits is growing nationally, and we're investing in the people, technology and capabilities that will support our next stage of growth.
A division of an established Canadian financial services organization, we have the stability and resources behind us to build for the future while remaining small enough that talented people can have a meaningful influence on where we're going.
Our employees work directly with senior Group Benefits leaders, including our President and Vice President. Ideas move quickly, expertise is valued and you'll have the opportunity to see the impact of your work.
We're looking for people who want more than a narrowly defined role. People who can get into the details, solve problems and understand the operation while also stepping back, thinking strategically and asking how we can make it better.
If you've built your Group Benefits expertise and are ready to use it to help build what's next, this could be the opportunity you've been looking for.
What We Offer
- Vacation and Earned Time Off program
- Group Retirement Savings Plan with employer match
- Employee benefits plus Health & Wellness Spending Account
- Educational assistance and career development
- One-hour early finish on Fridays
- Employee Assistance Program and employee discount programs
- On-site gym
- 5% bilingualism premium for qualified professional-level French bilingualism, where applicable
A seat close to the decision table and the authority to influence it.
You won't be several layers removed from the people determining the direction of the business.
You'll work directly with senior Group Benefits leadership and will have meaningful latitude to evaluate how your function operates, recommend changes, build capability and influence the future direction of the division.
What You’ll Shape
- The strategic direction and future capabilities of your function.
- Organizational structure, processes and operating models.
- Technology strategy, platform capabilities and vendor decisions.
- Service models and the experience provided to clients, advisors and members.
- Cross-functional priorities and how teams work together.
- Talent capability, leadership structure and succession.
- Investments and initiatives required to support future growth.
- The broader direction of the Group Benefits division through direct collaboration with the President and senior leadership.
As our business has grown, employees have had opportunities to expand their responsibilities and move into leadership positions. We're continuing to build the capabilities and leadership structure our future business will require.
Where you'll work
Our Group Benefits team works together in-office in Edmonton. We believe the stage we're at as a growing business benefits from close collaboration, immediate access to leaders and the ability to solve problems together.
What You'll Do
Essential Responsibilities:
- Lead the build-out of both the claims adjudication and plan administration teams, from recruitment and onboarding through to ongoing coaching and performance management.
- Design, implement and continuously refine end-to-end workflows for health and dental claims processing and group plan administration, ensuring accuracy, timeliness and regulatory compliance.
- Leverage your deep industry knowledge to develop best-practice solutions that scale with our growing client base.
- Champion the selection and ongoing development of our claims adjudication and administration technology platforms, serving as a key stakeholder in system enhancements.
- Conduct regular claims file reviews and performance assessments; translate trends into actionable process improvements and technology recommendations.
- Build and sustain a client service culture that puts members and Plan Sponsors first - handle escalations with professionalism and resolve disputes with fairness and speed.
- Provide ongoing training and development to ensure your teams are always equipped with current knowledge, tools and confidence.
- Report on operational KPIs to senior leadership and use data to drive continuous improvement.
- Other duties as assigned.
- 5-7+ years of experience in group benefits health and dental claims adjudication, with a thorough command of claims processing practices and relevant regulations.
- 3-5 years in a people leadership role, with demonstrated success building and leading high-performing teams.
- Proven experience designing or overhauling operational workflows in a claims or administration environment.
- Bachelor's degree in Business Administration, Human Resources or a related discipline (or equivalent experience).
- Exceptional organizational and analytical skills; comfortable managing competing priorities in a fast-moving environment.
- Outstanding written and verbal communication skills; able to translate complexity for diverse audiences.
- Proficient in Microsoft Office Suite; experience with claims or benefits administration software strongly preferred.
- Insurance designation (LOMA, CEBS/GBA, ICA) is a significant asset.
- Bilingual English/French is an asset.
- Successful completion of pre-employment screening (criminal, credit, education, reference and designation verification) is required.
Thank you for considering our organization.
We are an equal opportunities employer and welcome applications from all suitably qualified persons. Accommodations are available upon request.
More about this job
Responsibilities
Build and lead the claims adjudication and plan administration teams, designing scalable workflows and ensuring accurate, timely, and compliant health and dental claims processing. Oversee technology development, service escalations, staff training, performance reviews, and KPI reporting while using operational data to drive continuous improvement.
Requirements
Requires 5–7+ years of group benefits health and dental claims adjudication experience and 3–5 years of people leadership, including success designing or overhauling operational workflows. A bachelor's degree or equivalent experience is required, with strong organizational, analytical, communication, and Microsoft Office skills; insurance designations and English/French bilingualism are assets.
Skills
- Claims Adjudication
- Group Plan Administration
- People Leadership
- Team Building
- Workflow Design
- Operational Process Improvement
- Claims File Review
- Performance Management
- Claims Technology Platforms
- Regulatory Compliance
- Client Service
- Escalation and Dispute Resolution
- Training and Development
- KPI Reporting
- Data-Driven Decision-Making
- Microsoft Office
Benefits
- Vacation and Earned Time Off
- Group Retirement Savings Plan with Employer Match
- Employee Benefits
- Health and Wellness Spending Account
- Educational Assistance and Career Development
- Early Finish on Fridays
- Employee Assistance Program
- Employee Discount Programs
- On-Site Gym
- Bilingualism Premium
Visa sponsorship
Not detected in the job text
Categories
- Management & Leadership
- Finance & Accounting
- Customer Service & Support
- Administrative
Keywords
- Group Benefits
- Health Claims
- Dental Claims
- Claims Adjudication
- Plan Administration
- Claims Processing
- Regulatory Compliance
- Operational Workflows
- Process Improvement
- Claims File Reviews
- Performance Assessments
- Claims Administration Software
- Technology Platforms
- System Enhancements
- Client Service
- Plan Sponsors
- Member Experience
- Escalation Management
- Dispute Resolution
- Operational KPIs
- Microsoft Office Suite
- LOMA
- CEBS/GBA
- ICA
- Bilingual English/French