Manager, Group Health Claims

At Equitable, we believe work should be a place where you feel supported, inspired, and empowered to grow. In our caring and collaborative environment, your curiosity is encouraged, your passion is recognized, and your contributions truly matter. Together, we create meaningful impact, for our clients, our communities, and each other.

The Opportunity: At Equitable, we believe great things happen when we work together. We’re a Canadian mutual company driven by purpose - putting people first and helping Canadians protect today and prepare for tomorrow. If you’re passionate about making a difference and growing your career in an inclusive and collaborative environment, we’d love to hear from you. Our culture is built on care, passion and curiosity. We put people above all else, strive to be our best and welcome new ideas to deliver positive outcomes.

This is a high-impact leadership role within Group Health Claims, where you will drive operational excellence, lead a high-performing team, and optimize claims processes to enhance service, efficiency, and cost effectiveness. You’ll play a key role in delivering strategic initiatives, improving performance, and strengthening collaboration across teams and partners.

Join one of the region’s top employers and be part of something that truly makes a difference.

Work Arrangements: This is a hybrid role. You will work in our office in Waterloo, ON a minimum of two (2) assigned, consecutive days every other week, plus a fifth (5th) assigned day per month. You are welcome to work from the office more than the minimum requirement and there may be some roles that are required to work in our office more than the minimum requirement.

What you’ll do

• Lead and manage the day-to-day operations of the Group Health Claims team to ensure claims are processed accurately and within established service standards
• Provide leadership, coaching and direction to a team of claims adjudicators, including performance management, conflict resolution and career development
• Allocate and monitor team workload to ensure optimal staffing levels and timely completion of daily, weekly and monthly deliverables
• Partner with the leadership team to achieve key performance indicators and continuously improve operational efficiency
• Develop and oversee training programs, ensuring staff accuracy, knowledge development and cross-functional capability building
• Drive and implement cross-functional projects focused on improving processes, reducing costs and increasing overall effectiveness
• Act as the primary point of contact for internal and external audits, coordinating activities, reviewing findings and implementing corrective actions
• Collaborate with external partners to maintain a strong and effective claims management ecosystem
• Identify and implement ongoing process improvements to enhance service quality and operational efficiency
• Manage escalated claims issues and provide resolution for complex cases, ensuring strong client and stakeholder relationships
• Oversee reporting of operational metrics and performance data, applying insights to improve team outcomes
• Manage departmental budgets, monitor expenses and identify opportunities for cost optimization
• Ensure compliance with industry regulations, company policies and governance standards
• Maintain strong relationships with internal departments, group offices and third-party providers to support service delivery
• Stay informed on industry trends, legislative changes and competitor practices through involvement in industry forums and associations
• Partner closely with the Dental Claims Manager to align resources and achieve shared team objectives

What you’ll bring

• Post-secondary education or an equivalent combination of education and relevant work experience
• 5–7 years of progressive leadership experience, ideally within group health claims or insurance environments
• Strong medical and drug knowledge, with in-depth understanding of group health benefits, contracts and applicable legislation
• Demonstrated ability to lead, mentor and develop high-performing teams in a fast-paced operational setting
• Proven experience managing workflows, optimizing processes and driving continuous improvement initiatives
• Excellent interpersonal and relationship management skills, with the ability to collaborate across internal teams and external partners
• Strong analytical, problem-solving and decision-making skills, with the ability to manage competing priorities and deadlines
• Effective communication skills, both written and verbal, with the ability to influence and engage stakeholders at all levels
• Experience with project management and cross-functional initiatives; familiarity with agile methodologies is an asset
• Solid understanding of budget management, forecasting and cost control practices
• Strong attention to detail, organizational skills and ability to manage complex operational tasks
• Proficiency in Microsoft Office (especially Excel and Word) and experience with systems such as BMS and OnBase is an asset
• Change leadership mindset with the ability to guide teams through transformation and continuous improvement initiatives

What’s in it for you

• Career Growth: Regular learning sessions and development opportunities
• Total Rewards: Incentive pay, annual salary reviews, employer-paid benefits and pension matching
• Time Away: Competitive vacation plus one paid volunteer day each year
• Flexibility: Healthy work-life balance with employee wellness always top of mind, complemented by a “dress for your day” approach.

At Equitable, we’re committed to fair pay and an inclusive, accessible hiring experience. If you need accommodations or alternative formats at any stage, just reach out to us at View email address on ca.workus.org. We’re happy to help.

Your base pay will be based on your skills, qualifications, experience and education. In addition to your salary, this role is eligible for a discretionary annual incentive award tied to business performance, plus a wide range of competitive benefits.

If you’re selected to move forward, our Talent Acquisition team will walk you through all the details of our total rewards program, so you know exactly what’s included.

Reports To: Director, Group Claims

Department: Group Claims

Term: Permanent Full-Time

This position is open and we are excited to find the right person to join our team.

As part of the recruitment process, you will need to go through background screening, as per our company policy.