Reporting to the Supervisor, TPA Claims, the
Claims Analyst is responsible for the adjudication of medical claims in accordance with claim processing guidelines. We are seeking a dedicated and detail-oriented Group Benefit Claims Case management analyst to join our team. The successful candidate will be responsible for managing and processing group benefit claims, ensuring accuracy, compliance, and timely resolution. This role requires strong analytical skills, excellent communication abilities, and a commitment to providing exceptional service to our members.
What you will do:
- Operational Activities
- Review and process group benefits claims, including health, dental, and provincial replacement; in compliance with policy provisions, regulatory requirements, and internal guidelines, ensuring completion within the established turnaround time.
- Validate eligibility, coverage, and supporting documentation to ensure accurate adjudication.
- Compliance and Quality Assurance
- Ensure all claims are processed in compliance with industry regulations, privacy laws, and company standards.
- Maintain accurate records and documentation for audit and reporting purposes.
- Collaboration and Continuous Improvement
- Work closely with finance, case management and client service teams to resolve complex claim issues.
- Contribute to process improvement initiatives to enhance efficiency and accuracy.
- Stay current on industry practices, regulatory changes, and emerging technologies in claims management.
- Technology and System Utilization
- Use claims processing systems and tools effectively to adjudicate claims and maintain data integrity.
- Support system enhancements and participate in user acceptance testing when required.
- Verify eligibility of members and coverage details with the administrative team.
- Support service-level agreements (SLAs) for turnaround times.
- Share knowledge and best practices within the team.
- Suggest process improvements to enhance efficiency.
- Adapt to system updates and new technologies.
- Performance Metrics
- Verify eligibility of members and coverage details with the administrative team.
- Support service-level agreements (SLAs) for turnaround times.
- Share knowledge and best practices within the team.
- Suggest process improvements to enhance efficiency.
- Adapt to system updates and new technologies.
- Compliance Adherence: Alignment with policy provisions, regulatory requirements, and internal guidelines.
- System Accuracy: Correct data entry into claims systems.
- Fraud Detection: Identification and reporting of suspicious claims.
- Compliance with Privacy Laws: Adherence to confidentiality and data protection standards.
What you will bring:
- Post-secondary diploma in a related field or equivalent training
- Minimum of 1–2 years of experience in medical or dental administration, including familiarity with patient records and insurance claims processing.
- Strong attention to detail, organizational, time management and prioritization skills
- Demonstrate good judgement, reliability, and professionalism in fast paced environment
- Strong initiative, planning, and problem-solving skills, including an ability to focus on both details and results
- Excellent customer service skills and professionalism
- Comfortable working independently with minimal supervision
- Excellent written and verbal communication skills
- Bilingual, written and oral (English and French), is considered an asset
Who we are:
Proudly independent and Canadian-owned, Cowan Insurance Group has been a true market leader in the insurance industry since 1927. With an extensive range of product offerings and integrated commercial and personal insurance, group benefits, and wealth management solutions, we provide our clients with outstanding customized, comprehensive insurance and risk management professional advice and placement.
Recognized as one of Canada's Most Admired Cultures and a Canada's Best Managed Companies Platinum Club Member, Cowan Insurance Group's award-winning client-centric approach emphasizes innovation, excellence, and collaboration. Join our team as we prepare for our centennial celebration in 2027!
What sets us apart?
Be in good company
Integrity matters. It drives our award-winning workplace culture and fuels our collective desire to help our clients, employees, and communities thrive.
Challenge your thinking
You're valued for your passion, drive and creativity. The pace is fast but the work is meaningful, interesting, and complex, just the way you like it.
Grow together
We believe in your potential. If you’re looking to develop your expertise with learning opportunities and mentoring, we’ll make that happen.
Benefits and perks
- Competitive salary
- Participate in our comprehensive benefits plan on day one - no waiting period
- Company-matched Retirement Savings Plan
- Company-paid training and development courses
- Community involvement
- Hybrid work environment
Are you interested?
Please Apply!
This is a replacement position.
Artificial Intelligence (AI):
This position is subject to appropriate background checks that may include, credential, employment, credit, criminal and reference checks.
While we appreciate the interest of all applicants, we will contact only those selected for interviews. If you are an applicant with disabilities and require accommodations, please let us know at the time of our contact so that we may arrange for their provision.
We are an Equal Opportunity Employer. Candidates will be selected strictly on the basis of an individual's technical qualifications, knowledge and experience, as they relate to the requirements of a particular position. Selections will be made without regard to: age, ancestry, colour, race, citizenship, ethnic origin, place of origin, creed, disability, family status, marital status, gender identity, gender expression, record of offences, sex, or sexual orientation.
