Claims Processor
4 weeks ago
Description:
Express Scripts Canada administers on behalf of Indigenous Services Canada Claim 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.
Please note, this is a hybrid role working 2-3 days out of our Toronto office after completing 4 weeks of on-site all 5 days training.
Key Responsibilities:
- Register, review, validate, and adjudicate claims on a daily basis as per processes documented in the APM in English
- 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.
- Participate in annual Privacy and Compliance Training.
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
- Proficient verbal and written communication skills in English
- 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)
NOTE: Internal candidates should apply before March 26, 2024.
Express Scripts Canada is a Cigna company
Express Scripts Canada is a subsidiary of Express Scripts, a Cigna company. Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, wellbeing and peace of mind of those we serve. Cigna offers an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioural health, pharmacy, vision, supplemental benefits, and other related products.
About Express Scripts Canada
Express Scripts Canada is a leading health benefits manager and has been recognized as one of the most innovative. Our clients include Canada's leading insurers, third party administrators and governments. We work with these clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment. We provide Active PharmacyTM services to more than 7 million Canadian patients and adjudicate more than 100 million pharmacy, dental, and extended health claims annually. Through our proprietary consumer intelligence, clinical expertise, and patients-first approach, we promote better health decisions for plan members, while managing and reducing drug benefit costs for plan sponsors.
It will be a condition of employment that the successful candidate obtains an Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation to receive clearance if required.
We offer a competitive salary and benefits package, along with a positive work environment built on solid corporate values, integrity, mutual respect, collaboration, passion, service and alignment.
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.
We are committed to creating a working environment that is barrier-free and we are prepared to provide accommodation for people with disabilities.
If you require accommodation in completing the online application process, please email: - Do not email - for an update on your application or to provide your resume as you will not receive a response.
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