Claims Processor

One Team Health, a subsidiary of Argus Group Holdings Limited, is currently seeking a Claims Processor. This role will process will ensure that claims are reviewed and processed in a timely manner and within the service level requirements dictated in the provider contract. Ensuring to abide by the established company protocols and objectives.

We are seeking an individual who is well organized, enthusiastic, and who can consistently meet and exceed the expectations required for claims quality.

**PRIMARY DUTIES AND RESPONSIBILITIES**:

- Assist with sorting and scanning of new inbound claims received by post.
- Assist with managing the general Claims Mailbox for incoming claims
- Help manage claims pending system queues
- Prioritize Claims
- Check and confirm claim details
- Review all documentation provided with the claim
- Open a “General Only” case in the database system for non-managed claims
- Gather any necessary missing information
- Use the various key systems to assist with clarifications
- Track claims on tracker report
- Check and confirm benefits - source, condition type, benefit amount indicated in order to ensure sufficient details are provided to upload the claim in the system.
- Check repricing - network, percentage, UCR rate, assistant surgeon & anesthesia rules
- Notify the vendor of any revisions
- Add coding to non-standard International claims
- Assist with processing member reimbursement claims when applicable
- Communicate with members and providers on claims related inquiries
- Process travel claims when applicable
- Adding urgent notes into the system related to claims processing
- Request for a provider add to the system when missing
- Other tasks as requested by the department Manager

**REQUIREMENTS**:

- 3 -6 months Claims experience
- Ability to multi-task in a fast-paced environment
- Ability to prioritize and meet deadlines
- Detail oriented
- Excellent critical and analytical thinking skills
- Excellent working knowledge of Microsoft programs - Word, Excel, PowerPoint
- Superior written and verbal communication skills
- Ability to work independently or in a team environment
- Able to use discretion in dealing with confidential and sensitive information

**SKILLS/ATTRIBUTES**
- Discretion in dealing with confidential/sensitive information.
- Coordination and prioritization of time sensitive tasks.
- Proficient and accurate data entry skills
- Ability to concentrate attention for prolonged periods of time.
- Strong verbal and written communication skills
- Possess excellent organizational skills
- Strong analytical and problem solving skills
- Ability to set own priorities
- Work with mínimal supervision
- Team player/Flexible/Reliable
- Ability to manage stress

In Ontario, Argus Group Holdings, One Team Health, and affiliated organizations accommodate the needs of job applicants throughout its recruitment and selection processes in accordance with the Ontario Human Rights Code and the Accessibility for Ontarians with Disabilities Act. Accommodation needs must be provided in advance. To discuss your needs, please contact the individual noted in the posting.

**Job Types**: Full-time, Permanent

Additional pay:

- Bonus pay

**Benefits**:

- Extended health care
- RRSP match

Schedule:

- Monday to Friday

Application question(s):

- What is your salary expectation for this role?

**Experience**:

- claims processing: 1 year (preferred)

Work Location: Hybrid remote in North York, ON M2J 4Y1

Application deadline: 2024-12-17