Customer Service Representative

**Job Title – Claims Adjudicator/ Customer Service** **Period – 6 months** **Location – Nova Scotia, CAN** **Work mode : Remote** **Job Description** The Claims Adjudicator is accountable for handling claims in accordance with high service standards to meet or exceed client expectations. The Adjudicator is required to make determinations that may affect a members entitlement to benefits and/or the amount of benefits payable. The Adjudicator reviews claims for completeness, enters and assesses claims, and produces the final statement and/or payment responsibility after the members insurance benefits are applied. **Responsibilities** • Outline all daily duties, responsibilities, tasks, and accountabilities • Assess highly complex health/dental claims in accordance with contract provisions, taking initiative and ensuring empowered decision making is a key component of the process. • Assume ownership of assigned claims, understanding the urgency of specific cases and effectively prioritizing work accordingly. • Establish and maintain high quality customer service within turnaround times, using influence with internal and external clients to meet all preestablished service standards and delight customers. • Commitment to financial efficiency and continuous improvement targets, as required. • Commitment to improving NPS (customer) scores based on overall goals. Supporting the Business: • Sound knowledge and ability to apply appropriate risk management tools and techniques. • Actively participate in projects that improve the effectiveness and efficiency of claims practices in alignment with a culture of continuous improvement. • Manage all issues and requirements related to claims to achieve customer/claim resolution, handing off only when appropriate (claims adjustments, technical decisions). **Must\-Have (Hard Skills):** * Strong experience in claims review and adjudication, including the ability to evaluate insurance claims, verify policy coverage, and determine eligibility for settlement. * Excellent verbal and written communication skills, with the ability to interact effectively with internal and external stakeholders. * Proficiency in MS Office 365, with strong working knowledge of applications such as Word, Excel, and Outlook. * Highly detail\-oriented with strong analytical skills, capable of reviewing documents, extracting data, and ensuring accurate information processing. * Proven ability to work independently as well as collaboratively in a fast\-paced environment. **Soft Skills:** * Strong customer service orientation with a focus on delivering high\-quality support. * Demonstrated initiative and proactive approach to work. * Excellent interpersonal skills, with the ability to engage and collaborate with individuals at all organizational levels. **Nice\-to\-Have:** * Bilingual proficiency in English and French is an added advantage. * Prior experience in claims adjudication, insurance, or healthcare industry is preferred. * Experience in call center operations and/or data processing is a plus. * Exposure to working with legal, medical, or external service providers is desirable. ***Dexian is a leading provider of staffing, IT, and workforce solutions with over 12,000 employees and 70 locations worldwide. As one of the largest IT staffing companies and the 2nd largest minority\-owned staffing company in the U.S., Dexian was formed in 2023 through the merger of DISYS and Signature Consultants. Combining the best elements of its core companies, Dexian's platform connects talent, technology, and organizations to produce game\-changing results that help everyone achieve their ambitions and goals.*** ***Dexian's brands include Dexian DISYS, Dexian Signature Consultants, Dexian Government Solutions, Dexian Talent Development and Dexian IT Solutions. Visit https://dexian.com/ to learn more. Dexian is an Equal Opportunity Employer that recruits and hires qualified candidates without regard to race, religion, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status*** ***Note: Dexian Canada will, on request, provide accommodations for disabilities to support your participation in all aspects of our Recruitment and Assessment/Selection Processes.***