Workflow Co-ordinator

2 weeks ago

Toronto, Ontario, Canada Greenshield Holdings Full time

About Benecaid


A part of Green Shield Canada group of companies, Benecaid provides innovative health benefit solutions for the small-mid size companies in Canada.

Benecaid has long been recognized as the leading alternative to the traditional insurance companies, in a market where small and mid-sized employers have been largely underserved.

Benecaid sets itself apart from the competition, by using technology, creative product development and a stellar customer experience to solve problems for employers.

Honeybee Benefits is our next generation benefits platform built for today's modern workforce that empowers employers to compete better for talent.

The Workflow Coordinator (

CODE:
OPS-CLAIMS 001) is responsible for coordinating workflow by processing incoming claims, conducting claims audits, developing reporting, analyzing prior authorizations, managing mail, and providing sundry support to claims adjudicators.

You can effectively manage, execute, and delegate customer requests for services, and use discretion and judgment to assess client requests, gather appropriate additional information and determine if there are issues and concerns that must be escalated, or client expectations managed.


Under the supervision of the Claims Manager and as a member of the Claims team, you will be accountable for ensuring that all mail is sorted and forwarded to the applicable department or staff in timely and secured manner.


Specific Responsibilities & Accountabilities:

  • University Degree or College Diploma
  • Other certifications are an asset It is your responsibility to sort, scan and log all claims in the system accurately.
  • 13 years of experience in customer service or a related role
  • Knowledge of the insurance industry and relevant federal and state regulations
  • For French Bilingual, written, and oral communication skills required
  • Administration:
  • This requires coordination with colleagues, an expert knowledge of benefit services and processes, and a working knowledge of support software.
  • Sorts the mailedin claims ensuring it would be easy for the adjudicators to read and key in the claims
  • Executes all requests for escalation to specific departmental groups/specialists
  • Responsible for maintaining exceptional working knowledge of cross specialty service offerings
  • Provide input and improve the workflow processes and procedures for all Prior Authorizations (PAs).
  • Maintain a sense of urgency and respond to and followup on PA requests in a timely and efficient manner.
  • Generate departmental reports and use or distribute as needed. a) Approved PAs
  • Review the approved PAs from ESC
  • Create the Checklist
  • Send request for approval
  • Send approved PAs for coding
  • Track the approved PAs b) Declined PAs
  • Send respond to ESC to mail decline letter
  • Track the declined PAs
  • Misdirected PA
  • Forward to customer care to reach out to the member


 Appeals
  • Review the appeal basing on the information from ESC
  • Send evaluation for further review and decision c) Monthly PA reconciliation
  • Review the monthly statement from ESC
  • Send to Finance with recommendation

Accountability:

  • Maintain working knowledge and understanding of current and historical Benecaid products by assisting and managing the Drug Formularies (BN01G, BNFG, BN01 and EQFG).
  • Attend the monthly validation meetings hosted by ESC
  • Take notes on the important provincial initiatives or changes and determine the impact to Benecaid
  • Determine if the drugs reviewed during the Validation meeting needs to be removed from the Benecaid Formularies
  • Send request to ESC to remove DINs
  • Send out the Validation meeting notes
  • Monthly DIN additions
  • Update the Tracking Sheet with the necessary information
  • Send the updated sheet for review
  • Send request to remove or add DINs basing on the review
  • Attend review meetings
  • Equitable Formulary: EQFG
  • Determine the excluded/included DINs on the Exclusion Lists sent periodically by Equitable
  • Send request to ESC for coding
  • Ad Hoc, Miscellaneous, and other duties as assigned

Why us?

We offer a robust employee benefits offering including:

  • Dental care
  • Disability insurance
  • Employee assistance program
  • Extended health care
  • Life insurance
  • Onsite parking
  • Paid time off
  • RRSP match
  • Vision care
  • Wellness program

Schedule:

Monday to Friday

Supplemental pay types:

Bonus pay

Ability to commute/relocate:

Toronto, ON M9C 5L5:
reliably commute or plan to relocate before starting work (required)

Work Location:
In person

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