Job Title: Benefits Adjudication, Administration & Client Care Specialist

Position Summary

The Benefits Adjudication, Administration & Client Care Specialist plays a key role in managing and supporting employee benefits administration while delivering exceptional service to our clients. In this client-facing position, you will act as a trusted & integral operational resource for both clients and your internal team members, ensuring benefits programs are accurately administered, compliant, and delivered with exceptional service. You will assist with general office operations. This role requires strong technical expertise, independent judgment, and the ability to manage multiple priorities in a fast-paced Boutique Employee Benefits and Insurance Brokerage environment.

Key Responsibilities

Benefits Adjudication

• Review and adjudicate benefits claims in accordance with established policies, procedures, and regulatory guidelines.
• Determine claimant eligibility by analyzing documentation, medical evidence, and supporting documentation.
• Interpret plan provisions, contracts, and legislation to ensure accurate benefits decisions.
• Communicate decisions clearly to claimants, providers, and internal stakeholders in a timely manner.
• Maintain accurate and detailed case notes and documentation within claims management systems.
• Ensure timely processing of claims while meeting service level standards.
• Provide support to clients regarding Claim Portal Inquiries.

Client Service & Communication

• Contribute to delivering a high level of client service through timely, accurate support.
• Communicate professionally with clients, carriers, and internal team members.
• Help ensure a positive client experience by responding to requests promptly and courteously.

Benefits Administration

• Independently manage the day-to-day administration of employee benefits for multiple client accounts.
• Serve as a primary operational contact for clients, carriers, and dental offices on benefits-related matters.
• Support enrollment, change requests, and termination processing with carriers and clients.
• Help prepare and distribute benefits materials, including booklets, employee communications, and presentations.
• Respond to basic client and employee inquiries regarding benefits plans, escalating more complex issues to senior team members.
• Maintain accurate client and employee records in agency systems and carrier portals.
• Coordinate adjustments.
• Maintain and audit employee data and plan information within agency management systems and carrier portals.
• Support renewal cycles by preparing data, plan comparisons, and administrative deliverables.

Administrative & Operational Support

• Provide general administrative support to the President, Operations Manager and Marketing team.
• Organize and maintain digital files, client documentation, and correspondence.
• Assist with preparation of reports, spreadsheets, and plan summaries.
• Help track deadlines, renewals, and compliance requirements.
• Support IT & prepare the Office Supply order.

Client Support

• Respond to complex client and employee inquiries regarding benefits plans, eligibility, and claims processes.
• Provide guidance on benefits administration procedures and recommend process improvements.
• Support the company by preparing client-ready materials such as reports, summaries, and presentation decks.

Administrative Leadership & Process Management

• Lead and refine administrative workflows to improve efficiency and accuracy.
• Identify and implement process improvements within benefits administration and client service delivery.

Data, Reporting & Compliance

• Enter and update employee and plan data in agency management systems and carrier platforms.
• Perform routine data checks to ensure accuracy and completeness.
• Produce and analyze benefits-related reports, including enrollment summaries, audits, and carrier data reconciliations.
• Ensure adherence to internal controls and industry best practices.
• Assist with audits (internal and external), including data validation and documentation preparation.

Carrier & Vendor Coordination

• Act as liaison with insurance carriers, third-party administrators, and vendors.
• Resolve escalated issues and ensure timely follow-up on outstanding items.
• Support implementation of new plans, renewals, and carrier transitions.

Qualifications

Education

• Post-secondary education in Business, HR, or a related field (required).

Experience

• 4–7 years of experience in employee benefits administration, insurance brokerage, HR operations, or a similar role.
• Prior experience in an insurance company, insurance brokerage or multi-client environment strongly preferred.
• Experience handling complex benefits plans (e.g., group health, dental, retirement, or specialty benefits) is an asset.

Technical Skills

• Strong proficiency in all Microsoft tools with a focus on Excel, Word & PowerPoint as well as expertise with ADOBE.
• Experience with agency management systems, carrier portals & CRM Systems.
• Ability to analyze data and generate accurate, client-ready reports.
• Familiarity with Plan administration processes.

Skills & Competencies

• Deep understanding of employee benefits plans and insurance carrier processes.
• Variety of work across multiple client accounts, offering broad exposure and learning opportunities.
• Strong problem-solving abilities and attention to detail.
• Excellent communication skills, with the ability to explain complex concepts clearly.
• Proven ability to manage multiple client accounts and competing deadlines.
• High level of professionalism and discretion with confidential information.
• Strong client service orientation with a proactive, consultative mindset.
• Ability to work independently while contributing to a collaborative team.

Role Expectations

• Operate with a high degree of autonomy, managing assigned tasks and projects with minimal supervision.
• Maintain a strong focus on accuracy, compliance, and client satisfaction.
• Contribute to the overall success and reputation of the company through high-quality service delivery

Work Environment

• Boutique, close-knit team with direct interaction with clients and company leadership.
• This role is On-Site.
• Workdays are Monday to Thursday 8:00 AM to 5:00 PM and Friday 8:00 AM to 4:00 PM with 1 hour lunch breaks daily.
• Warm environment with onsite free parking.

Compensation

Compensation inclusive of Benefits will be commensurate with experience.