We are seeking a Claims Team Lead to join our BPA team in North York/Vaughan.

The Claims Team Lead directs the daily activities and provides support for the loggers and adjudicators on the team. The Claims Team Lead is responsible for the efficient and effective daily operation of staff to assess medical and dental claims.

The Claims Team Lead will:

Train new staff and develop skills of existing staff. Maintain personal files and record.

• Conduct yearly performance evaluations for the staff on the team.
• Review, examine and direct the processing of unusual or complex claim cases.
• Responsible for maintaining the daily claims turnaround claims.
• Receives, reviews and distributes all incoming mail to ensure claim loggers and adjudicators receive appropriate number and type of claims.
• Responsible for the training of new staff members, ongoing training and development of claims staff.
• Co-ordinate and distribute to claims adjudicators all faxes and/or returned mail of all outstanding documents for pending claims.
• Responsible for processing claims as per policy provisions with accuracy.
• Sets up exceptions on Adjudicare.
• Overrides Dental Clinic claims if an override is required.
• Review and process adjustments from both the claims department and customer service department.
Sends the adjudicators an email of the workflow for all E-Claims and E-Dental submitted electronically.
• Handling all stop-payment requests, sent to GWL and Telus.
• Co-ordinate distribution and receipt of all claims that are sent to dental consultant, and work at home staff.
• Produce daily claims production reports for the Operations Manager.
• Correspond and communicate via telephone, written correspondence or fact-to-face with members, providers, consultants or other internal or external customers.
• Transfers claims history on the AS400, when an affidavit is submitted.
• Assists with claims adjudication paper or electronic to maintain the 5-Day turnaround.
• Other duties as may be assigned from time to time by Management.

To be successful as a Claims Team Lead, you will need:

• To be willing to develop knowledge of leadership principles and techniques and applies that knowledge to direct and motivate employees.
• To be skilled in decision-making and has in-depth knowledge of claim examination procedures.
• To be compliant with government regulation pertaining to the Privacy Act (PPEIDA)
• Knowledge and proper interpretation of contract wording.
• Strong verbal, written communication skills and attention to detail while maintaining exceptional customer service skills.
• Strong organizational and interpersonal skills.
• Ability to manage multiple cases simultaneously.
• Participation in Company sponsored insurance programs such as FLMI, ACS, ALHC, C.E.B.S. and successful completion of these courses of study during tenure in the position;
• Intermediate computer skills in the use of related computer applications, including Microsoft Word, Excel and Outlook, AS400, Telus/ Adjudicare in order to enter and track program data, process claims, prepare reports and correspondence.

All star candidates will have:

• 2 plus years in a benefit related or claims department work experience.
• University or College degree or equivalent work experience.

About BPA:
BPA is a division of People Corporation and has served members and beneficiaries in their local communities since 1958. BPA is dedicated to providing a superior benefits experience to our members, businesses, and trusts in the local communities in which they live and operate.