Accident and Health Claims Adjudicator - Level 1

We are currently recruiting for an Accident and Health Adjudicator to join our team remotely in Canada. The position location is flexible, and we can offer in-office, hybrid or fully remote working arrangements.

Salary range is $50,000 to $74,000 annually.

• Assess low-complexity Affinity claims (travel, baggage, simple reimbursements).
• Determine benefit entitlement according to policy and claims handling processes.
• Collect and analyze additional data (e.g., medical information).
• Resolve inquiries promptly and maintain client/referral relations.
• Make timely first contact on new claims and gather additional information to expedite decisions.
• Prepare verbal and written reports supporting decisions.
• Record detailed progress notes and prepare correspondence using approved templates.
• Ensure accurate eligibility determination and adherence to turnaround timelines.
• Maintain reserves, obtain necessary authority, and process payments promptly.
• Submit accurate billing and expense reports on time.
• Provide timely responses to claimants and stakeholders.
• Document all communications in the system.

• Minimum 3 years Accident and Health Adjudication experience
• Full Provincial Adjusting License or CIP designation is required 
• Post Secondary education in an insurance related field considered an asset
• Experience in adjusting including the investigation and detailed reporting of multi-line claims
• Excellent ability to interact with clients, claimants, and field staff for the exchange of information often requiring analysis
• Excellent interpersonal abilities are required to enable effective interaction and communication in both oral and written format with employees, policyholders, employers and other insurance/medical/legal professionals
• The ability and willingness to learn multiple computer systems
• Strong analytical and decision making skills
• Ability to multi task
• Ability to effectively manage change
• Strong computer and reporting skills including Office 360 and Windows10
• Must be a team player with outstanding customer service skills
• Willingness to work in a dynamic environment with opportunity for career growth

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