Group Benefits Claims Adjudicator (Bilingual)

At EIO, we help small businesses deliver better employee benefits and workplace experiences—supporting employee well-being while enabling employers to attract and retain top talent. Our approach is practical and data-driven, grounded in what we call Employee Investment Optimization.As part of our fully remote team, you’ll enjoy flexibility, competitive compensation and benefits, and opportunities for professional growth within a collaborative and high-performing environment. We’re proud of the culture we’ve built and are entering an exciting phase of growth. If you’re thoughtful, motivated, and interested in contributing to meaningful work, EIO offers a place to build and grow your career. Join us and be part of what’s next.
About the Position:
We are seeking a Group Benefits Claims Adjudicator and Benefits Support Specialist to support our TPA operations. In this role, you will be the heartbeat of our health and dental claims processing including HCSA, Wellness and Cost-Plus, ensuring that member inquiries are resolved quickly and adjudications are handled with precision. Working closely with our insurance carriers and partners, you’ll help maintain our high standards of service in a fully remote, fast-paced environment.
In this role, you’ll be:

• Executing daily claims adjudication and providing direct support to our members.
• Managing member inquiries and tickets using HubSpot Helpdesk.
• Following and refining internal SOPs to ensure seamless benefits administration.
• Coordinating with insurance carriers and TELUS claims partners to resolve routine processing issues.
• Collaborating with the EIO team on projects

Who This Role Is Perfect ForThis role is ideal for a detail-oriented professional with a foundation in group benefits, who loves helping people and solving puzzles. You might currently be a claims assistant or a customer service representative in the insurance space looking to specialize in TPA operations.
You’ll do well in this role if you:

• Take immense pride in accuracy and delivering a "wow" experience for members.
• Are a problem-solver who enjoys digging into plan documents to find answers.
• Thrive in a hands-on environment where you manage your own desk and priorities.
• Communicate clearly and empathetically in both French and English.
• Want a remote role where you can grow your technical knowledge of Canadian benefits.

What You’ll Be Doing

• Member Support: Act as the first point of contact for member inquiries via HubSpot, resolving tickets related to coverage and claims and supporting members as needed to complete applications for provincial drug programs.
• Process & Adjudicate Claims: Handle daily health and dental claims processing ensuring accuracy and alignment with specific plan documents.
• Carrier Liaison: Coordinate with insurance carriers and TELUS Adjudicare to troubleshoot submission errors or eligibility issues.
• SOP Documentation: Assist in documenting and updating internal workflows to keep our operations running smoothly.
• Data Accuracy: Support group setup, plan member onboarding, and data entry within our administration systems if needed.
• Bilingual Service: Provide high-quality support in both French and English
• Compliance: Maintain strict adherence to privacy and regulatory requirements (PHIPA / PIPEDA).
• Plan Designs: Assist with the creation of new group benefits booklets and updates and review to get to know the plan designs

Must-Have Skills & Experience

• Bilingualism: Fluency in French and English (written and verbal) is required.
• Experience: 1–3+ years in claims adjudication, benefits administration, or a TPA/insurance environment.
• Technical Savvy: Experience with TELUS Adjudicare is a very strong asset; comfort using HubSpot or similar ticketing systems is preferred.
• Knowledge Base: A solid understanding of Canadian extended health and dental plans (Life, AD&D, Health, Dental, HCSA).
• Detail Oriented: Ability to interpret plan designs and assist with the creation of complex benefit booklets and ASO/HSA plan structures.
• Self-Starter: Proven ability to work independently and stay organized in a fully remote setting.

Why You’ll Love Working With Us

• Fully Remote: Work from anywhere in Canada.
• Growth Potential: Gain deep technical expertise in a growing organization.
• Impact: Your work directly helps members navigate their health and wellness benefits.
• Modern Tools: Work with a tech-forward stack (HubSpot, TELUS, Slack) instead of legacy systems.