Medical Benefits Enquiries Customer Service

2 weeks ago

Victoria, British Columbia, Canada Maximus Full time

Company Profile:


Maximus Canada is an industry leader in the provisioning of products and services to support the delivery of government services in North America and internationally.

With operations across Canada and around the globe, Maximus provides innovative, practical and meaningful solutions to help government programs and services function more effectively and efficiently.

We are constantly assessing new technology, processes and methods of delivering services to the citizens of Canada.

With our expertise in program information management, claims processing, contact centre services, document processing and information technology, we are positioned for significant growth.


Maximus Canada offers competitive market-based salaries, comprehensive employer-paid benefits and a defined-benefit pension plan or a Group RSP with employer-matching contributions, for eligible employees.

Our people also get some great perks too, such as employee appreciation events throughout the year, along with a supportive results-oriented work environment.


Job Description:

Department Overview
On behalf of the B.C.

government, Health Insurance BC (HIBC) administers medical coverage through the Medical Services Plan (MSP) and drug coverage through the PharmaCare and Fair PharmaCare programs.

With a staff of ~180 unionized employees and 3 excluded managers, the HIBC Operations department delivers services measured by 20 SLRs and 29 SLOs via four teams:

  • Customer Service (PharmaCare Help Desk, Service Desk, Info Support, and Prosthetics and Orthotics)
  • Document Operations (Document Management, Document Processing, Admin Review, and Correspondence Liaison Unit)
  • Practitioner and Patient Services (Provider Programs, Benefit Services, Billing Support, and In Province and Out of Country Adjudication)
  • Operational Support Services (Medical Services and Pharmaceutical Services Support, Production Control, Support Coordinators)

Role Summary
This position reviews, researches and responds to enquiries within a call centre environment.

Calls can regard:

  • Medical benefits
  • Medical Histories
  • Practitioner registration and account maintenance
  • Claims submissions
  • Travel assistance
  • Payments for health care professionals, hospitals, clinics, laboratories, and the general public.
  • Alternative payment incentive programs
  • Teleplan Connectivity/support


In addition to call centre functions, this position is responsible for assessing and processing requests for the release of personal medical and Pharmacare information, court orders, beneficiary's reimbursement requests for services, and for the registration and account maintenance of physicians and other medical providers eligible to participate in MSP.

This position additionally works with Providers and Data Centres that submit claims electronically via a computer system called Teleplan.

The Clerk registers them in the system, then works with them (via a call centre) to ensure that they have connectivity, passwords and appropriate access.


This position also administers and maintains multiple special incentive programs for practitioners, including the calculation of payments based on program rules, payment processing, and payment tracking.


An extremely high level of privacy adherence, accuracy and professionalism is required in this role as it involves reviewing and discussing patient/practitioner histories and the maintenance of banking information.


Key Responsibilities

  • Answer and complete public and provider calls to meet our Average Speed of Answer and to provide excellent customer service.
  • Process documents provided by the public and providers, via HIBC forms and correspondence, to meet our SLR.
  • Process requests for reimbursements submitted by the public, via HIBC forms and correspondence, to meet our SLA.
  • Process requests for medical histories to meet our SLA.
  • Understand and comply to MAXIMUS, legislated and client policies and work procedures accurately, 98% of the time to meet our Quality SLR and to provide excellent customer service.
  • Manage your interactions with callers, clients and colleagues respectfully, collaboratively and professionally to contribute to a harmonious, productive work environment.

Education and Experience
Before Hiring
- proficient knowledge of MS Office, Outlook, ability to operate standard office equipment

  • 23 years clerical experience in a documentation processing environment, preferred
- experience explaining policies and programs to internal/external stakeholders, preferred

Understanding Principles of:
- call control and customer situational judgment
- customer service
- plain language communication
- professional, pro-social inter-relations
- privacy and security of personal information

Knowledge, Skills and Abilities
Systems Use (B=basic A=advanced, E=expert)

MS Word:

B Outlook:

B CCA:

A MaxImage:
A R&PB: A PharmaNet: A CICS/

CIPS:

A MaxPath:
A

Answer public and provider calls
- articulate cl

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