Weixi Li

Detail-oriented Group Benefits Claims Professional with 5 years of experience in claims auditing, system logic, and escalation management. Skilled at interpreting complex contract wording and testing claims systems (MPACS, Claim Secure). Experienced managing carrier relationships within the Canadian group benefits industry. GBA Candidate with a Master of Health Science from the University of Toronto.

Health and Dental Claims Best Practice Associate (administering claims for GroupHealth) - Manion Wilkins - Etobicoke

(2025-08)

• Conducted complex, client-wide audits, including double-deductible reconciliations and manual reviews to ensure financial accuracy of claims processed through the pharmacy benefit manager, identifying whether discrepancies result from processing errors.
• Performed large prescription drug claim audits, comparing prior carrier payments with current reimbursement and identifying multiple plan set-up discrepancies to support onboarding transitions of 2 new union clients.
• Assisted with contract wording reviews for new and existing Manion clients, having completed reviews of two client booklets to date; identified enhanced wording for overpayment recoupment and ensured benefits are reflected clearly and accurately.
• Completed insurer-requested audits, researching claim history and providing feedback on audit findings.
• Acted as team lead for a team of 5 examiners handling customer complaints and escalations exclusively, providing guidance and recommendations to support resolution.
• Researched claims history in response to Ombudsman complaints, insurer escalations, and MunichRE audits.
• Provided feedback on 3 claims system enhancements based on day-to-day processing experience.

Health and Dental Claims Level 4 Specialist / Team Lead - Manion Wilkins - Etobicoke

(2022-10 - 2025-07)

• Proposed a change to the member portal that removed manual specialist workarounds, cutting administrative work by about 75%.
• Partnered with Account Executives and Plan Administrators to resolve high-level claim escalations and complete large client health and dental benefit audits.
• Reviewed approximately 80–90% of ex gratia exception requests and processed reimbursements in line with MunichRE standards.
• Worked with the Chief Actuary to review and refine group insurance contract wording, advising on orthopaedic shoe coverage and special vision benefits.
• Built a centralized SharePoint resource for Health & Dental guidelines and provided training on adjudicating dental accident and nursing care benefits.

Health and Dental Claims Level 2 Adjudicator - Manion Wilkins - Etobicoke

(2021-07 - 2022-10)

• Exceeded daily adjudication target of 175 lines per day, averaging 209 lines per day within the first year, while maintaining 99% audit accuracy across dental, drug, EHC, and HSA benefits.
• Identified and recovered mismanaged banking data on Cost Plus accounts; worked with Finance to reissue reimbursements to the correct clients.

Health and Dental Claims Level 1 Processor - Manion Wilkins - Etobicoke

(2021-01 - 2021-06)

• Consistently exceeded daily adjudication and line-per-day targets of over 200 claim lines per day within the first six months, while maintaining accuracy.

Lead Regional Coordinator - Alberta - Project Northern Lights - Alberta

(2020-08 - 2021-04)

• Demonstrated professional customer service and research skills in liaising with local organizations (i.e. food banks, long-term care homes) to assess needs for personal protective equipment through cold-calling and emails.
• Coordinated the pickup and delivery of PPE from our local makers to our recipient organizations.

Master of Health Science - Translational Research Program - University of Toronto (2019)

Honours B.Sc. - Molecular Biology and Chemistry - University of Toronto (2017)