Bilingual Claims Adjudicator (Insurance) in Canada Creek, Nova Scotia at Jobgether

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Bilingual Claims Adjudicator (Insurance) in Canada.

This role offers an opportunity to contribute directly to the accurate and timely assessment of health and dental insurance claims within a modern, transformation-focused environment. You will work in a fully remote setting, supporting the transition to cloud-based systems while ensuring members receive fair and efficient claim decisions. The position combines analytical precision, customer service, and operational execution in a fast-paced insurance context. You will collaborate closely with internal teams and external stakeholders to resolve claims-related issues and maintain service excellence. With exposure to evolving digital claims platforms, this role is ideal for professionals seeking to grow within the insurance and benefits industry. It also provides a strong foundation for long-term development and potential career progression.

You will be responsible for evaluating, processing, and managing insurance claims while ensuring accuracy, compliance, and strong service delivery in a high-volume environment.

• Assess and adjudicate health and dental claims in line with policy provisions and service standards
• Review claim submissions for completeness, verify eligibility, and determine payable amounts
• Enter and process claim data accurately within internal systems
• Manage assigned claims queues, prioritizing urgent and complex cases appropriately
• Communicate with internal teams, members, and external stakeholders to resolve inquiries and ensure service quality
• Support risk management practices and contribute to operational accuracy and financial efficiency
• Participate in system transition initiatives and continuous improvement projects
• Escalate and resolve claims issues, including adjustments and technical decision support when required

This role requires strong analytical abilities, attention to detail, and excellent communication skills, along with the ability to operate effectively in a fast-paced insurance environment.

• Bachelor’s degree in Business or a related field
• 0–2 years of experience in insurance, healthcare, call center, or data processing environments (asset)
• Exposure to claims adjudication, eligibility verification, or benefits administration is an advantage
• Strong bilingual proficiency in English and French (mandatory)
• High attention to detail with strong data entry and analytical capabilities
• Proficiency in Microsoft Office 365 applications
• Strong customer service mindset and ability to communicate clearly with diverse stakeholders
• Ability to work independently while also contributing effectively in a team setting
• Strong time management, prioritization, and adaptability in a dynamic workload environment

• Fully remote work flexibility
• Competitive hourly compensation
• 6-month contract with potential for permanent employment
• Full-time schedule (37.5 hours per week, standard daytime hours)
• Exposure to modern cloud-based insurance systems and digital transformation projects
• Career development opportunities within the insurance and benefits industry
• Collaborative team environment with strong operational support
• Opportunity to build experience in claims adjudication and customer service excellence