Ensure that service standards are met or exceeded.

• Interact with plan members and service providers via phone and email to provide responses to inquiries about claims, eligibility and services.

• Obtain, analyze, and verify the accuracy of claim submissions and data.

• Initiate and/or implement correct action as needed to ensure an excellent service standard and a high level of client satisfaction is maintained.

• Maintain security and confidentiality of client information.

• Actively participate in training on new product offerings and various process updates.

• Actively participates in huddles & team meetings, and share learnings in a constructive manner. To be successful as a Claims Adjudication Specialist with People Corporation, you will need:

• 3+ years of relevant professional experience in a service related role (Insurance, Health & Dental benefits claims)

• Demonstrated expertise in customer service, with a strong focus on anticipating, meeting, and exceeding customer needs.

• Excellent analytical skills and strong attention to detail.

• Sound knowledge of Microsoft Office and standard office administration procedures.

• Consistent and clear communication, addressing concerns respectfully with excellent verbal and written abilities.

• To make independent decisions in non-routine situations, applying guidelines effectively and considering risks and consequences.

• Experience handling multiple competing tasks accurately and efficiently, and managing time effectively.

As a Claims Adjudication Representative on our Customer Experience team, you’ll review Health Spending Account (HSA) and Wellness Spending Account (WSA) claims and make reimbursement decisions based on each member’s plan details and adjudication guidelines. Your decisions need to be accurate, consistent, and fair, and your communication with members needs to be clear, helpful, and respectful. If you like detail-oriented work that directly affects how people use their benefits, this role is for you. What You’ll Do

• Review HSA and WSA claims, checking receipts and supporting documentation to confirm each claim is valid and eligible

• Apply eligibility criteria and plan rules to make consistent, well-reasoned, and unbiased reimbursement decisions

• Make sure every decision complies with internal policies, external regulations, and industry standards

• Communicate clearly with members about claim outcomes and any additional information needed

• Work with Support and other departments to resolve member inquiries smoothly

• Flag emerging patterns, unclear guidelines, or repeated issues to the Adjudication Coordinators and Head of Experience so they can be reviewed and acted on

• Take part in team discussions and process improvement work

• Keep up with changes to guidelines, regulations, and plan rules through ongoing training

• Handle private and sensitive information with care, following our security and privacy standards What You Bring

• Strong analytical and critical thinking skills

• Excellent attention to detail and accuracy

• Clear written and verbal communication, with a professional, solution-oriented tone