Appeals Analyst

Schedule: Monday to Friday, 37.5 hours per week

WHO WE ARE

The Public Service Health Care Plan (PSHCP) is a private health care benefit program sponsored by the Government of Canada, offered to public servants and other members of the federal public administration, parliamentarians, federal judges, pensioners, members of the Canadian Forces and the RCMP, and their eligible dependants. The PSHCP currently offers coverage to over 1,5 million participants.

The PSHCP Administration Authority is a corporation without share capital whose mandate is to oversee the administration of the Plan. The Administration Authority ensures that the Plan Administrator delivers benefits efficiently and effectively to PSHCP members in accordance with the Plan provisions. We have several operational and reporting responsibilities, such as:

• Ensuring that service standards outlined in the Contract are met;
• Conducting audits and evaluations regarding the payment of PSHCP benefits;
• Processing appeals submitted by Plan members;
• Communicating with Plan members about their benefits;
• Providing accurate, comprehensive, and up-to-date information on Plan performance;
• Providing direction to the Administrator on the interpretation of Plan provisions; and
• Reporting incidents of fraud.

WHAT YOU WILL DO

The appeal process is available to all Plan members who do not agree with a decision of the Plan Administrator regarding a benefit entitlement and/or a decision relating to their coverage. To request an appeal, the Plan member must submit a letter to the Administration Authority requesting a review. As an Appeals Analyst, you will be responsible for the management and preparation of appeals for review by the Appeals Committee of the PSHCP Board of Directors. More specifically, you will:

• Open appeal files by assigning a case number, preparing the files and entering key information in the database;
• Review, research, investigate and analyze formal appeal cases;
• Communicate with appropriate parties to obtain additional information – this includes representatives of the Plan Administrator, compensation advisors and the pension office;
• Prepare and draft analytical summaries of each case;
• Participate in Appeals Committee meetings by presenting the case summaries and providing plan design information;
• Review administrative cases and authorize resolution where required;
• Prepare correspondence in response to appeals, including the preparation and mailing of acknowledgement letters, status update letters, decision letters and follow-up letters;
• Assist in the preparation of reports;
• Participate in the research of complex cases or issues.

You will also provide assistance to the communications functional area by:

• Responding to requests for information from the membership and other stakeholders, track progress and maintain records;
• Writing, editing and proofreading various content in both French and English;
• Providing administrative support on special projects and initiatives.

REQUIREMENTS

EDUCATION AND EXPERIENCE

• Fluent bilingualism (French and English)
• Post-secondary education (University degree or College diploma)
• Minimum of 3 years of experience in a related field. A suitable combination of education and experience will be considered.

KNOWLEDGE AND SKILLS

• Excellent writing skills in French and English are essential.
• The candidate must have the ability to write, edit, revise and present content in both official languages.
• Proven ability to communicate professionally and effectively with both internal and external stakeholders.
• Experience in operating word processing and presentation software (i.e. Microsoft Office Suite, Sharepoint).
• Must be organized and thrive in a fast-paced environment with multiple priorities.
• Ability to analyze and synthesize data from various and multiple sources.
• Ability to work effectively under pressure, as part of a team and individually.
• Knowledge of the health insurance industry and the PSHCP is an asset.

WHAT YOU CAN EXPECT

• Compensation: The PSHCP Administration Authority offers a competitive salary, and employees may be eligible for in-range increases and economic adjustments. Employees receive additional compensation in lieu of a pension benefit.
• Vacation and leave: Employees start with 3 weeks of paid vacation, 15 illness days, and 5 days of Family-Related Leave with pay. Employees may also benefit from other paid and unpaid leave of absence.
• Learning and Development: The PSHCP Administration Authority prioritizes career growth and professional development. You will have the full support of your leaders and colleagues to further your career through continuing education and professional development opportunities.
• Benefits: The PSHCP Administration Authority offers a comprehensive health and dental benefits package, as well as long-term disability, and life insurance.

CONDITIONS OF EMPLOYMENT

• Government of Canada Reliability Status security clearance (will be facilitated upon employment);
• The applicant must reside in Canada and within a reasonable commuting distance from the workplace;
• Vaccination requirements may apply in response to changing public health advice and/or government direction.

Applicants are encouraged to provide a detailed cover letter, along with their résumé, explaining how they meet the requirement of this position.

A written test in both official languages will be administered as part of the recruiting process.

The Federal PSHCP Administration Authority is an equal opportunity employer. In accordance with the Accessibility for Ontarians with Disabilities Act, 2005, upon request, accommodation will be provided by the Administration Authority throughout the recruitment, selection and/or assessment process to applicants with disabilities.

We thank all individuals who apply; however, only candidates selected for further consideration will be contacted.