Claims Representative
6 days ago
Manitoba Blue Cross was born out of a desire to protect our fellow Manitobans during life's most unexpected and sometimes challenging moments.
This remains our driving force today, and fuels our ongoing commitment to providing superior health and wellness benefits that are delivered with compassion and excellence in service.
As an independent and not for profit organization for over 40 years, we provide health, dental, employee assistance, disability, travel and life coverage to over half a million Manitobans.
At Manitoba Blue Cross, our people are the key to our success Consider becoming part of our team of professionals committed to providing exceptional customer service.
JOB TITLE:
CLAIMS REPRESENTATIVE (1 year Term)
REPORTS TO:
Team Lead, Claims
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.
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 precalculated claims with nonstandard 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 12 years' related experience.
- 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.
- 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 selfdirected 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.
All qualified applicants will receive consideration for employment without regard to race, national or ethnic origin, colour, religion, age, sex, sexual orientation, gender identity or expression, marital status, family status, genetic characteristics, disability and conviction for an offence for which a pardon has been granted or in respect of which a record suspension has been ordered.
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