Claims Adjudication Representative

Description:

My HSA, a division of People Corporation, is a leader in providing innovative, cloud-based health benefits solutions to Canadian employees. Since 2013, the company has transformed the traditionally paper-based industry by offering simple, personalized, and employee-centric benefits programs. myHSA is currently hiring a Claims Adjudication Representative to join its growing team in Calgary. This is a fully remote position and offers comprehensive training, making it an excellent opportunity for individuals seeking to start a career in the health and wellness claims adjudication field.

The Claims Adjudication Representative will be responsible for assessing Health Spending Account (HSA) and Wellness Spending Account (WSA) claims submitted by employees. The role involves reviewing supporting documentation, evaluating the validity of receipts, and applying policy guidelines to ensure fair, accurate, and timely reimbursement decisions. This position plays a key part in maintaining the integrity and efficiency of the claims adjudication process.

Key Responsibilities:

• Claims Assessment: Evaluate submitted HSA and WSA claims to determine their eligibility according to established policies and procedures.

• Evidence Analysis: Review receipts and supporting documentation to confirm relevance and validity.

• Decision Making: Use provided guidelines to make consistent and objective reimbursement decisions.

• Compliance: Ensure adherence to internal policies, industry standards, and applicable regulations.

• Customer Service: Respond professionally to claimant inquiries and provide clear explanations about decisions and additional documentation requirements.

• Continuous Learning: Stay informed of updates to adjudication guidelines and attend training sessions.

• Fairness and Equity: Make unbiased decisions and contribute to a fair, inclusive adjudication process.

Qualifications:

• No previous experience in the industry is necessary – full training will be provided.

• Strong attention to detail and analytical thinking skills.

• Proficiency with technology; ability to learn proprietary claims management software.

• Effective verbal and written communication skills.

• Ability to work independently and manage time effectively in a remote setting.

• A customer-focused mindset with a commitment to quality service delivery.

Compensation & Benefits:

• Monthly Salary: CAD 3750 to 4167 (Annual base: CAD 45,000–50,000)

• Extended health care and dental benefits.

• Company-sponsored retirement savings plan.

• A variety of Health & Wellness programs.

• Mental health support for employees and their families.

• Opportunities to learn directly from industry professionals.

• A positive and inclusive work environment with growth potential.