Medical Claims Processor jobs

Preferential hiring is given to candidates of Indigenous ancestry including status and non-status First Nations, Metis and Inuit. We encourage applicants to include this information in their email subject line when applying.

Description:

Our partner and client, Express Scripts Canada, administers on behalf of Health Canada Claims Adjudication. This role entails adjudicating Non-Insured Health Benefit Dental Claims for Indigenous people in Canada.

The role of a Claims Processor is to register, review, validate, and adjudicate claims on a daily basis ensuring data integrity in the system. Claims Processors are responsible for processing Pay Provider, Pay Client and Client Reimbursement claims for all regions and are responsible for ensuring all pended claims are processed within the standard turn-around time.

This role is instrumental in meeting our Claims Processing Service Levels which contributes to customer satisfaction and minimizes risk of financial penalties.

Key Responsibilities:

• Register, review, validate, and adjudicate claims on a daily basis as per processes documented in the APM
• Monitor and handle pended claims to ensure they are settled according to the Service Level Standards
• Prepare and send a Dental Provider Missing Information Return Form based on the requestor’s communication preference (mail or fax) and language preference for claims with missing or illegible data
• Consistently meet the minimum accuracy standards of 98%
• Consistently meet the productivity standards for assigned quotas within the established Service Delivery Standards
• Participate in frequent quality and productivity touchpoints
• Engage in bi-weekly claim department and monthly benefit process meetings
• Handle claim adjustments that are provided from various departments
• Perform other duties and responsibilities as assigned to support operational needs

Qualifications:

• 1+ years’ experience with data entry with proven records of excellent accuracy
• Experience working in an operational setting an asset
• Experience in the group insurance industry an asset Strong focus on customer service is required
• Quick learner and ability to make decisions with minimal supervision
• Strong analytical skills and ability to work or interpret data independently
• Self-motivation, determination and ability to work effectively in a fast paced, rapidly changing environment
• Excellent time management, organizational and interpersonal skills
• Working knowledge of Microsoft Office Suite of Tools (Word, Excel, Outlook)

Physical Demands/Working Conditions:

• Office and Call Center environment
• No heavy lifting
• Intermittent walking within the Claims Department for Team support
• Comfortable work stations

Benefits of Working with FCH:

• Inclusive work environment
• Generous Group Benefits with Pension
• Generous PTO
• Team culture

We are an equal opportunity employer that promotes a diverse, inclusive and accessible workplace. By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be.

At First Canadian Health, we embrace our diversity. We strive to attract, develop, and retain a workforce that is as diverse as the customers we serve and to foster an inclusive work environment that embraces the strength of cultures and individuals. We are committed to fair recruitment, retention, advancement and compensation, and we administer all of our practices and programs without discrimination on the basis of race, ancestry, place of origin, colour, ethnic origin, citizenship, religion or religious beliefs, creed, sex (including pregnancy and pregnancy-related conditions), sexual orientation, genetic characteristics, veteran status, gender identity, gender expression, age, marital status, family status, disability, or any other ground protected by applicable law.

It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will work with applicants who request reasonable accommodation during the application process. All information shared during the accommodation request process will be stored and used in a manner that is consistent with applicable laws and First Canadian Health policies. To request a reasonable accommodation in the application process, contact cbajona@fchealth.biz

For more information about First Canadian Health, and our parent company, Tribal Councils Investment Group, please visit:

https://firstcanadianhealth.biz/ http://www.tcig.biz/

Resume can be emailed to:

HR Administrator: emusgrove@fchealth.biz

Pay: $42,000.00-$44,000.00 per year

Ability to commute/relocate:

• Toronto, ON M4N 3N1: reliably commute or plan to relocate before starting work (required)

Application question(s):

• There is a bona fide requirement of being granted security clearance through the Government of Canada for this position. Can you meet all of the following security clearance requirements: At least 18 years of age, Lived in Canada for the past 5 years, Able to clear a criminal record check
• Preferential hiring is given to Indigenous candidates for this position, though it is not a requirement. Do you identify as an Indigenous person in Canada?

Experience:

• Data entry: 1 year (preferred)

Work Location: Hybrid remote in Toronto, ON M4N 3N1