**Fixed-Term - Maternity Leave (12 to 18 months)**

The Manager, Claims Management is responsible for overseeing and directing the Claims Management department by:

a) Ensuring benefit adjudication and administration systems are working and programming of plan details are captured accurately;

b) Overseeing the efficient and timely response for adjudication and administration of benefit claims;

c) Supporting and providing direction to team members to deliver effective resolution to member inquiries and any escalated member issues;

d) Acting as a liaison between Team Leads, Executives and Clients; and

e) Ensuring regulatory requirements are followed & met for all processes and procedures across the Claims Management department.

Responsibilities:

Claims Adjudication

• Conducts a daily review of system related problems and issues that have been escalated by members, then takes effective action to resolve.

• Ensures the system used for benefit adjudication is up to date including adjusting dollar values as rates of coverage change (or any benefit improvements).

• Manages the turnaround times on adjudication and allocates resources based on the workload and/or advises Team Lead to reallocate resources to emergency or high priority situations.

• Sets target metrics for claims adjudication and addresses any issues related to not meeting these targets.

• Works with 3rd party TPP company to create new plan or member cards by completing required forms to set up the appropriate template and metrics for coverage.

• Reviews monthly “unclaimed property” list provided by 3rd parties and assigns to a team member to confirm if cheque should be issued or if the 3rd party should move the unclaimed funds to the Bank of Canada.

• Reviews monthly “terrorist watch” list received from insurance carriers and provides timely responses to any questions regarding members as requested.

• Evaluates monthly “delisted clinic” listings received from insurance carriers and updates the system or distributes to the Claims Adjudicators to verify the claim against the list.

• Disability and Life claims:

  • Conducts a review prior to issuing payments for each payment cycle to ensure proper deductions are made on payments and ensures related files are up to date.
  • Confirms Global is the plan sponsor and provides final signature on LTD applications.

Customer Support (Call Centre)

• Ensures that all plan accounts are set up and appropriate access permissions are granted to team members.
• Manages the efficiencies and outputs of the call centre by reviewing the queue for “Hold” times, abandoned calls and understanding why there were abandoned.
• Creates schedule to ensure sufficient coverage for Customer Care Specialists breaks, lunch, vacation and sick time coverage.
• Acts as primary escalation point and the main contact when Customer Support Specialists are unable to resolve problems that arise through member emails or phone calls.

Claims Administration

• Oversees claims processes including pay direct, eligibility escalations, and reporting (e.g., disabled members).
• Manages payment cycles, final sign off for any cheque/EFT approvals, and rate updates within the system.
• Coordinates with accounting and external stakeholders to ensure accurate and timely payments.
• Supports tax processes (T4), including corrections and communication with CRA and members.

Management / Leadership

• Recruits, develops, and supports the Claims Management team to drive performance and engagement.
• Provides coaching, training, and ensures compliance with regulations and best practices.
• Oversees onboarding and continuous development of team members.
• Prepares and delivers communications to members, unions, and internal stakeholders.

Mandatory Skills and Competencies

• Demonstrates strong leadership by motivating teams, fostering collaboration, and aligning performance with organizational goals.
• Effectively manages people by setting clear expectations, delegating responsibilities, and supporting team development.
• Possesses strong analytical skills and the ability to interpret data to make informed recommendations.
• Communicates effectively in both written and verbal formats while guiding and influencing team performance.
• Maintains proficiency in Microsoft Office (especially Word and Excel), ensures accurate data handling, and applies relevant regulations within the claims process.

Education & Demonstrated Experience:

• Bachelor’s Degree or College Diploma in Business, Administration or related.
• 3-5 years prior experience working in in the benefits industry is required
• 2+ years’ experience leading a team
• Certified Employee Benefits Specialist (CEBS) designation or working towards completion is an asset

Work Environment and Physical, Auditory & Visual Demands:

• Work requires extended periods of sitting, and focused cognitive, visual and/or auditory concentration
• Standard office work conditions (hybrid home/office)

Founded in 1961 as RMT Employee Benefit Plan Consultants Inc and evolved to Global Benefits to better reflect the diversified service we provide to Pension, Health and Welfare and Group Legal plans Nationwide.

Global Benefits has over 50 years experience providing high quality and cost effective administration for Multi-Employee Trusteed plans and single employer benefit plans.

At People Corporation we are committed to helping businesses succeed. We are a national provider of benefits, retirement, wealth, wellness, and human resource solutions. Our experts and solutions serve over 20,000 clients representing nearly 3 million Canadians. We offer customized solutions designed to fit the unique needs of businesses and their employees, members and stakeholders.

We are committed to providing an inclusive, accessible environment, where all employees and clients feel valued, respected and supported. We are dedicated to building a workforce that reflects the diversity of the communities in which we live, and to creating an environment where every employee has the opportunity to reach their potential. If you require an accommodation or an alternative format of any posting please reach out to careers@peoplecorporation.com .

The base salary range for this position is $100,000- 120,000 per annum, competitive and commensurate with experience.