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Medical Claims jobs in Ottawa, ON

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    • Complete medical follow-ups (Return to Health Plans);
    • Minimum of 3 years work experience in a workers’ compensation claims management capacity either at the…
    • Group medical and dental benefits.
    • Process treatment plans, insurance claims, and payments.
    • Welcome and assist patients with warmth and professionalism.
    • Assist in preparing responses for arbitration and human rights claims.
    • Reporting to the VP-Human Resources, you will serve as a strategic advisor and partner to…
    • Ensure timely and thorough investigation and adjudication of medical claims.
    • Answer queries from customers, legal representatives and medical clinics while…
    • Ensure timely and thorough investigation and adjudication of medical claims.
    • Answer queries from customers, legal representatives and medical clinics while…
    • Incident/claims data analysis for trend identification.
    • WSIB/CNESST claims processes, documentation, and appeals.
    • Supporting Joint Health and Safety Committees.
    • Assignment protocols for claims and service requests.
    • Champion prompt resolution of claim escalations and team discrepancies.
    • Valid G Driver's License.
    • Training Materials: You will update and maintain technical documentation, the claims manual and all claim' handbooks.
    • Participation in the profit share program.
    • Inform buyers and sellers on the process, cost, and timing for completion of all claims.
    • Review customer claims to verify that they meet Arbitration policies…
    • Experience in drafting pleadings, affidavits, and written submissions, and preparing summaries of medical and financial documents.
    • Ensure timely and thorough investigation and adjudication of medical claims.
    • Answer queries from customers, legal representatives and medical clinics while…
    • Hold decision-making authority and lead the identification, mitigation, and elimination of project risks and uncertainties, directing staff to operate in a…
    • Investigate disability claims to verify the authenticity of reported injuries or illnesses, including conducting interviews, reviewing medical records, and…
    • Develop policies and procedures for MSD prevention by maintaining knowledge of current trends, practices and related medical issues.
    • Proficiency with electronic medical records systems such as Epic or Dentrix.
    • Strong knowledge of medical terminology relevant to dentistry and general…
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Job Post Details

Sr. Claims Specialist - job post

Windley Ely
2.4 out of 5 stars
Ottawa, ON K1P 6L5•Hybrid work
$50,000–$60,000 a year - Permanent, Full-time

Job details

Pay

  • $50,000–$60,000 a year

Job type

  • Permanent
  • Full-time

Location

Ottawa, ON K1P 6L5•Hybrid work

Benefits

Pulled from the full job description

  • Tuition reimbursement
  • Vision care
  • Dental care
  • Life insurance
  • Employee assistance program
  • Disability insurance
  • Company pension

Full job description

Sr. Claims Specialist Job Description

Reports to: Team Lead

Employment Responsibilities

· The Team Lead works with the Sr. Claims Specialist determining what claims are to be transferred to the Senior Claims Specialist, with the following parameters being in place:

o Maximum Medical Recovery not obtained > 6 months;

  • Claims costs over > $50,000;
  • Other non-compensable legal / material issues (i.e. Non-Cooperation, additional complications due to stakeholders);
  • Wage replacement benefits paid > 120 days; and,
  • Client Request to be escalated.
  • Manage High Impact Claims – remove obstacles;
  • Call to the WCB’s to obtain any missing information and move the files along;
  • Complete medical follow-ups (Return to Health Plans);
  • Complete return to work follow-ups (Return to Work Plans);
  • Complete return to work meetings;
  • Respond to client inquiries; and,
  • Provide Account Manager with detailed breakdown of next steps for training purposes

Qualifications:

· Minimum of 3 years work experience in a workers’ compensation claims management capacity either at the WSIB/WCB (or a similar provincial workers’ compensation board-commission) or in an in-house capacity at a private company with corresponding knowledge of workers’ compensation statutes, policies and procedures, experience rating analysis and workplace health and safety.

· Supervisory experience and a high level of oral and written communication skills.

· Ability to work within a demanding and fast paced environment

· Personal initiative and ability to work independently and to meet deadlines

· Familiarly with Microsoft products

· Post secondary education, preferably in a related field, or a human resources and or health and safety and or insurance certificate designation are assets. In absence of these qualifications, significant consideration will be given to applicants with claims management experience.

· Paralegal license would be an asset.

- This is for a current open position

Pay: $50,000.00-$60,000.00 per year

Benefits:

  • Company pension
  • Dental care
  • Disability insurance
  • Employee assistance program
  • Life insurance
  • Tuition reimbursement
  • Vision care
  • Work from home

Work Location: Hybrid remote in Ottawa, ON K1P 6L5

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