POSITION SUMMARY

The Claims Representative assesses, adjudicates and processes standard and diverse Health Spending Account, Ambulance and Hospital, Health and Dental Benefit claims in an accurate and timely manner.  The incumbent must work well independently as well as in a team setting.

DUTIES AND RESPONSIBILITIES

• Adjudicates and processes standard and diverse Health Spending Account, Ambulance and Hospital, Extended Health, Prescription Drug, Vision and Dental claims in accordance with performance standards
• Communicates with members and providers during the course of claims assessment.
• Adjudicates and processes pre-calculated claims with non-standard procedures.
• Adjudicates and processes preauthorized claims.
• Adjudicates and processes claims for coordination of benefits.
• Assists in the management of the Claims Workplace as assigned.
• Processes claims for groups with Service Level Agreements within the standards set out in the agreement.
• Returns claims for completeness of information and obtains any necessary additional information from both members and providers.
• Assists members and providers regarding claiming procedures.
• Responds to customer inquiries, particularly those of a complex nature.
• Processes bonds and returned cheque requests.
• Manages and updates Coordination of Benefits (COB) information received from Information/Customer Services and Client Administration.
• Maintains production report and weekly claim count.
• Performs other related duties as assigned.

SKILLS AND QUALIFICATIONS:

• Dedicated to the principles of exceptional service; committed to responding to, anticipating and addressing customer needs for both internal and external customers.  Capable of communicating effectively with subscribers and providers in a professional manner.
• College Diploma or equivalent combination of education and 1-2 years’ related experience.
• Strong computer skills including Word, Excel and e-mail software.
• Strong problem solving, analytical and numerical abilities.
• Excellent interpersonal and communication skills.
• Excellent organizational skills with the ability to manage and prioritize several activities on an ongoing basis.
• Ability to work independently as well as in a team setting.
• Ability to learn and use MBC applications relevant to the Claims department.
• Previous claims adjudication experience and/or experience in the health field an asset.
• Knowledge of pharmacy and medical products, dental and their terminology an asset.
• Completion of medical certificate courses an asset.
• Capable of completing industry education programs entailing a self-directed study and the writing of graded examinations.  Specific programs include but are not limited to LOMA, CEBS and ICA .  Enrollment in, and completion of, such courses will be encouraged.

SPECIAL CONDITIONS:

• Overtime may be required during peak periods.

We offer competitive salary, modified benefits, hybrid work arrangements, a flex work schedule, and a health and wellness program with an on-site fitness centre. We are committed to creating a rewarding environment to foster learning and development for our staff. If you are interested in joining our team, please forward a resume and cover letter, indicating salary expectations, by November 2.