Senior Client Benefits Specialist

With its expanding activities, AGA Benefit Solutions offers new employment prospects for professionals with high career aspirations. If you are seeking flexibility, freedom and challenges, this position is made for you!

Our firm is committed to its employees and welcomes all new candidates in a respectful manner consistent with an excellent work environment.

Your mandate will consist in:

Your mandate will be to manage the administration, analysis, auditing, and day-to-day operations of complex group benefit plans. You will act as a subject matter expert on benefits, contracts, billing, eligibility, and administration, while working with clients, insurers, consultants, and internal teams to resolve issues and ensure accurate plan management. The role requires strong knowledge of group benefits, an analytical mindset, and an affinity for systems and databases. Read on to discover the skills and qualifications needed to succeed at AGA!

Your main tasks will include:

Benefits Administration Oversight & Eligibility Management

• Oversee the administration of member eligibility, enrolments, terminations, beneficiary updates, dependent changes, and other benefit transactions to ensure accuracy and compliance with plan provisions.
• Review and validate member and plan data to maintain accurate records and support effective plan administration.
• Coordinate and manage annual enrolment activities, benefit changes, and complex eligibility situations.
• Manage over-age dependent reviews and ensure eligibility requirements and supporting documentation are met.
• Prepare, validate, and transmit eligibility and benefits information to insurers and third-party providers.
• Ensure member records are maintained in accordance with privacy, confidentiality, and regulatory requirements.

Contract Interpretation & Benefits Expertise

• Interpret and apply group insurance contracts, policies, employee booklets, and administrative agreements.
• Serve as a subject matter expert on group benefits administration, insurance provisions, and industry practices.
• Apply specialized knowledge of:
  • - Eligibility and enrolment requirements
  • - Disability, EI, and WSIB/WCB-related benefit administration
  • - Contract and policy provisions
  • - Life insurance provisions and beneficiary designations
  • - Non-evidence maximum rules
• Identify and resolve discrepancies between contractual requirements, insurer practices, and administration system configurations.
• Provide guidance to clients, insurers, consultants, and internal stakeholders regarding complex benefit matters.

Data Analysis, Auditing & Reconciliation

• Analyze member, eligibility, billing, and insurer data to identify trends, discrepancies, risks, and required corrective actions.
• Reconcile information across benefit administration systems, insurer records, and client data sources.
• Conduct audits to ensure data integrity, contractual compliance, and accuracy of member and plan information.
• Investigate and resolve eligibility, coverage, enrolment, premium, billing, and administrative discrepancies.
• Prepare and review reports, analyses, and supporting documentation to support client service, decision-making, and operational performance.
• Monitor administrative processes and identify opportunities to improve data quality and operational effectiveness.

Billing & Financial Administration

• Audit insurer billing statements and premium calculations to ensure plan changes and rates are accurately reflected.
• Review billing adjustments, reconciliations, member payments, and financial transactions related to benefit plans.
• Identify, investigate, and resolve billing discrepancies with insurers, clients, and internal stakeholders.
• Prepare monthly billing and financial reporting/remittance requirement for specified clients.
• Assist with benefit-related tax reporting, including T4A production, as required.

Client Relationship Management & Member Support

• Act as the primary day-to-day contact for assigned clients, providing expert guidance on benefits administration and plan operations.
• Respond to complex inquiries regarding eligibility, coverage, claims, premiums, flexible benefit programs, disability benefits, and insurer processes.
• Build and maintain collaborative relationships with clients, members, consultants, insurers, and internal stakeholders.
• Investigate and resolve escalated member and client issues in a professional and timely manner.
• Support members in navigating insurer and benefits administration platforms and understanding plan provisions.
• Ensure service standards are consistently met while delivering a high-quality client experience.

Process Improvement, Documentation & Training

• Identify recurring administrative and operational issues, conduct root cause analysis, and recommend solutions.
• Contribute to the development and implementation of process improvements that enhance efficiency, accuracy, and service quality.
• Develop, maintain, and update process documentation, workflows, and standard operating procedures.
• Support onboarding, training, and knowledge sharing within the team.
• Deliver member education sessions, benefits presentations, and client training programs.
• Communicate complex technical benefit information clearly and effectively to diverse audiences.

Operational & Project Support

• Prepare member communications, correspondence, reports, presentations, and other administrative documentation.
• Participate in client implementations, renewals, audits, and special projects.
• Collaborate with internal teams to support operational objectives and continuous improvement initiatives.
• Perform other related duties consistent with the senior nature of the role.

Required Qualifications:

• Minimum of 5 years of Group Benefits administration, insurance, payroll, HR administration, finance, data administration or a related field;
• College diploma or equivalent experience;
• System integration experience;
• CEBS certification is an asset;
• Bilingualism in both official languages is an asset;
• Knowledge of Group health insurance plans for a Multi employer or Flex environment is an asset;
• Advanced computer proficiency incl. MS Office; Word and Excel and ability to learn new applications;
• Strong mathematical, analytical and problem-solving skills;
• Superior attention to detail;
• Excellent oral, written, interpersonal, and communication skills;
• Ability to multi-task effectively and work closely with others in a team environment and independently, must be a self-starter;
• Ability to meet deadlines and work effectively under pressure of time limits.