Workflow Coordinator

2 weeks ago

Etobicoke, Canada Greenshield Holdings Full time

**About Greenshield**

Green Shield is the first integrated health services organization in Canada that is both a payer (offering insurance, administering benefits, and paying claims) and a provider (offering medical, mental health, and pharmacy services).

This evolution also deepens our social mission through both financial support and the direct delivery of services to support local communities and underserved populations across Canada.

As a part of Greenshield group of companies, Greenshield Administration provides innovative health benefit solutions for the small-mid size companies in Canada. Recognized as the leading alternative to the traditional insurance companies, in a market where small and mid-sized employers have been largely underserved Greenshield Administration 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 is responsible for delivering high-quality, service-oriented, professional outcomes to support claims processing. As the Workflow Coordinator, you are responsible for coordinating workflow by processing incoming claims, conducting claims audits, developing reporting, analyzing prior authorizations, managing mail, and providing sundry support to claims processors. You have the ability to 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.

**Responsibilities and Accountabilities**:

- Administration: This requires coordination with colleagues, an expert knowledge of benefit services and processes, and a working knowledge of support software
- Sorts the mailed-in 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 follow-up 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

a) Declined PAs
- Send respond to ESC to mail decline letter
- Track the declined PAs
- Mis-directed 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

b) Monthly PA reconciliation
- Review the monthly statement from ESC
- Send to Finance with recommendation

Accountabilities:

- 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

**Skills, knowledge and experience**:

- 1-3 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
- Proficient in Microsoft Office
- Self-starter with demonstrated ability to prioritize case load
- Excellent data entry skills
- Excellent verbal and written communication skills to effectively communicate with internal and external clients
- Ability to work collaboratively as a team and/or independently
- Ability to exercise flexibility, initiative, good judgement, and discretion
- Excellent organizational and interpersonal skills
- Attention to detail
- Self-motivated to effectively multi-task and be comfortable with tight deadlines; results oriented
- Analytical with a problem-solving attitude

Fixed term contract duration: 3 months

**Why us?**

We offer a robust employee benefits offering including:

- Dental care
- Disability insurance
- Empl

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