Dental/Health Adjudicator - Dental Claims

Job summary

The Dental/Health Adjudicator is responsible for accurately processing dental and health claims within established service standards. They also identify and resolve claim situations while collaborating with internal departments to detect suspicious activity.

Job details

At Equitable, we believe work should be a place where you feel supported, inspired, and empowered to grow. In our caring and collaborative environment, your curiosity is encouraged, your passion is recognized, and your contributions truly matter. Together, we create meaningful impact, for our clients, our communities, and each other. The Opportunity: ​ At Equitable, we believe great things happen when we work together. We’re a Canadian mutual company driven by purpose - putting people first and helping Canadians protect today and prepare for tomorrow. If you’re passionate about making a difference and growing your career in an inclusive and collaborative environment, we’d love to hear from you. Our culture is built on care, passion and curiosity. We put people above all else, strive to be our best and welcome new ideas to deliver positive outcomes. We are looking for a Dental and Health Adjudicator – Dental Claims to join our growing team at Equitable. This is a great opportunity for someone looking for a career that involves providing excellent client service in group benefits. The Dental/Health Claims Adjudicator – Dental Claims is responsible for processing dental/health claims. Join one of the region’s top employers and be part of something that truly makes a difference. Work Arrangements: This is a hybrid role. You will work in our office in Waterloo, ON a minimum of two (2) assigned, consecutive days every other week, plus a fifth (5th) assigned day per month. You are welcome to work from the office more than the minimum requirement and there may be some roles that are required to work in our office more than the minimum requirement. What you’ll do: Process dental/health claims and predeterminations accurately in a timely manner within established service standards and metrics Identify and resolve claim situations in a timely manner, through consultations with a Senior, Manager, or other departments within the Group division Work with the Investigative Claims Unit to identify suspicious claims and alert the department Contribute to the continuous improvement of business processes Additional basic tasks within dental/health, as required. What you’ll bring: ​​A flexible schedule with the ability to work additional hours when required Outstanding client service skills Handle high stress situations in a fast-paced production environment Excellent interpersonal and communication skills Demonstrate high attention to detail Capable of interpreting and applying claim guidelines while working through ambiguous situations Must be comfortable working in an environment with quickly changing priorities Able to work independently with little supervision Strong organization, multi-tasking, prioritization, and problem-solving skills. We’re committed to fair pay and an inclusive, accessible hiring experience. If you need accommodations or alternative formats at any stage, just reach out to us at careers@equitable.ca. We’re happy to help. If you’re selected to move forward, our Talent Acquisition team will walk you through all the details of our total rewards program, so you know exactly what’s included. This position is open and we are excited to find the right person to join our team. Your base pay will be based on your skills, qualifications, experience and education. At Equitable, your resume will be reviewed by real people and all hiring decisions are made by our recruiters and hiring managers. AI tools may be used to support administrative and productivity tasks throughout the recruitment process, but we believe that evaluating experience, skills, and talent potential requires meaningful human interaction. As part of our commitment to maintaining a secure and trusted workplace, candidates selected to move forward in the recruitment process will be required to complete a background screening in accordance with company policy. Reports To: Manager, Group Dental Claims and Group Claims Support Department: Group Term: Temporary Full-Time, Twelve (12) Month Contract Schedule: This role requires full-time hours (approximately 37.5 hours per week) from November to April during peak season, transitioning to part-time hours (approximately 15-20 hours per week) from May to October. This position is open and we are excited to find the right person to join our team. As part of the recruitment process, you will need to go through background screening, as per our company policy. #LI-Hybrid

What you’ll do

The Dental/Health Adjudicator is responsible for accurately processing dental and health claims within established service standards. They also identify and resolve claim situations while collaborating with internal departments to detect suspicious activity.

Requirements

Candidates must possess strong organizational, multi-tasking, and client service skills with the ability to work in a fast-paced, high-stress environment. The role requires the ability to interpret claim guidelines and work independently with minimal supervision.

Listed skills

• Time management · Preferred
• Customer service · Preferred
• Problem solving · Preferred
• interpersonal skills · Preferred
• Attention to detail · Preferred
• Multi-Tasking · Preferred
• Prioritization · Preferred
• Communication Skills · Preferred
• Conflict Resolution · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Dental claims processing
• Health claims processing
• Client service
• Attention to detail
• Interpersonal skills
• Communication skills
• Problem-solving
• Multi-tasking
• Prioritization
• Time management
• Analytical skills
• Conflict resolution
• Claims Support
• Claims Resolution
• Curiosity
• Service Standards
• Adjudication
• Business Process
• Communication
• Continuous Improvement Process
• Dental Health
• Development Environment
• Problem Solving
• Multitasking
• Detail Oriented

Job areas

• Finance & Accounting
• Customer Service & Support
• Administrative
• Healthcare
• Claims Adjudicator
• Claims Processor
• Statistical, Finance and Insurance Clerks
• Insurance Claims and Policy Processing Clerks