Business Application Specialist

6 days ago


North York, Canada One Team Health Inc Full time

One Team Health, a subsidiary of Argus Group Holdings Limited, is currently seeking a Business Application Specialist. This role will assist the Business Solutions Team lead with overseeing the operations by managing the implementation of business technology solutions to facilitate effective change management and business transformation.

An approachable professional with leadership abilities who will provide support and guidance, with a high level of stakeholder interaction and is a key liaison for vendor management within the department.

**PRIMARY DUTIES AND RESPONSIBILITIES**:

- Build and maintain configuration components including fee schedules, medical and dental procedure codes, diagnosis codes and benefit plans with the core administration and claim management system
- Modernize and automate processes to streamline systems operations with knowledge of Agile and Waterfall methodologies
- Working knowledge of Electronic Data Interchange (EDI) data files, configurations, and formats (837P, 837I, ANSI X12 V.5010 X12,file format requirements)
- Electronic data interchange (EDI) analysts who can implement and maintain data interchange systems between companies or departments (Imports files and export files, eligibility files)
- Coordinate end-to-end EDI testing and able to support setup of new EDI connections between trading partners and develop, modify, and document mappings as per EDI specifications (835 remittance file, setting up SFTP (Secure File Transfer Protocol), set up credentials for client’s access to their SFTP, EDI file name requirements)
- Provides advice and education to clients concerning EDI guidelines and capabilities. (EDI Requirements, Companion Guide, Segments and loops, trading partner)
- Remain current regarding EDI and internet field technological developments
- Working knowledge of Application Programming Interfaces (API)
- Remain current regarding EDI and internet field technological developments
- Conduct business analysis, determine and implement a course of action, set priorities, and recognize and take into account changing events and conditions during projects
- Work with the quality assurance team to validate test plans
- Analyzing current systems and processes to identify areas of improvement
- Implementing process changes as required by the solution design
- Creates and manages process documentation including workflow diagrams
- Collaborates with vendors, IT and business resources to test new or modified systems.
- Provide primary support for the health claims and administration system. Quantum Choice (QC) experience preferred
- Develop SQL queries and validate data and databases as required
- Communicate with clients and providers, respond to customers and service providers on dental and health coverage breakdowns, policy limitations and claims processing
- Conduct quality audits of claims, pre and post payments, utilizing appropriate sources of information, including eligibility, enrollment, contracts, providers and facilities, ensuring there are no errors in entry, coverage allocation or payment
- Prepare complex claim reviews for submission to Manager / Special Investigations Unit

**REQUIREMENTS**
- Post-Secondary education in related filed or equivalent work experience
- A thorough knowledge of health and dental claims policy and procedures and knowledge of Claim management and administration system - Quantum Choice (QC) experience an asset
- Certifications in the Health Insurance Field is an asset
- Ability to multi-task in a face-paced environment and work well under pressure
- Ability to prioritize and meet deadlines
- Excellent working knowledge of Microsoft programs - Word, Excel, PowerPoint, SharePoint
- Strong interpersonal, communication and customer service skills
- Proficient in change management
- Proven track record of collaborating effectively in cross-functional teams
- Working knowledge of Ontario Dental (Dental Codes, Fee schedule, etc..), US Dental and International Dental codes and schedules is an asset
- Dental chair-side or equivalent experience is an asset

**SKILLS/ATTRIBUTES**
- Excellent critical and analytical thinking skills
- Excellent written, organizational skills and verbal skills
- Critical thinker and problem-solving skills
- Team player/Flexible/Reliable
- Coordination and prioritization of time sensitive activities
- Discretion in dealing with confidential/sensitive information.
- Coordination and prioritization of time sensitive tasks.

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.

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

**Benefits**:

- Dental care
- Extended health care
- RRSP match
- Vision care

Schedule:

- Monday to Friday

Supplemental pay types:



  • North York, Canada CCR Business Information Limited Full time

    **French/English Bilingual Business Information Specialist** Excellent entry level opportunity for a bright, energetic individual with a superior telephone manner and strong written English skills. We are a well-established business information services firm, providing consumer and commercial credit reports and employment screening reports. The position...


  • North York, Canada CCR Business Information Limited Full time

    **French/English Business Information Specialist Position** Excellent entry level opportunity for a bright, energetic individual with a superior telephone manner and strong written English skills. We are a well-established business information services firm, providing consumer and commercial credit reports and employment screening reports. This is a full...

  • Instructor: Business

    3 weeks ago


    North York, Canada TORONTO BUSINESS COLLEGE Full time

    Toronto Business College is a private career college that has partnered with an Ontario community college to offer programs to international students in the GTA. Our goal is to provide our students with the theoretical knowledge and practical skills required to thrive in the increasingly dynamic workforce. We strive to offer the most relevant programs and...


  • North York, Canada AGM Advantage Full time

    **Business Development Specialist** **This is NOT a remote position!** **About Us**: AGM Advantage is a dynamic and innovative marketing company. With a commitment to excellence and a focus on delivering top-notch [products/services], we are poised for rapid growth in the fundraising industry. **Job Overview**: **Responsibilities**: - Research and...


  • North York, Canada TORONTO BUSINESS COLLEGE Full time

    Toronto Business College is seeking to hire a part-time instructor for our Business Sales and Marketing program. The courses will be delivered **on campus** to international students. **Disciplines within the program include**: - Business Computer Applications - Excel - Introduction to Business Sales and Marketing - Customer Service - Event Marketing and...


  • North York, Canada StoreForce Full time

    StoreForce is deeply passionate about Specialty Retail - it’s in our roots. Every day we strive to help Specialty Retailers set a new standard for operational excellence and accelerate their results. We focus on building intuitive and powerful, made-for-retail software and support them with experienced, knowledgeable retail professionals who have walked in...


  • North York, Canada CCR Business Information Limited Full time

    A unique entry level opportunity for a bright, energetic individual with a great telephone manner and strong written English skills. We are a well-established business information services firm, providing consumer and commercial credit reports and employment screening reports. This is a full time, permanent position with a starting wage of $20/hr We are...


  • North York, Canada Brydon Gama Full time

    **Business Development & Brand Engagement Specialist** **Location**: Remote | Hybrid (Canada-based) **Compensation**: 100% Commission-Based **About Brydon Gama** Brydon Gama is a boutique recruitment agency specializing in **IT and digital transformation hiring**. With a reputation for **building strong industry relationships and delivering top talent**,...


  • North York, Canada Wireless DNA Inc. Full time

    **Description/Purpose**: Some after-hours and weekend work are required depending on scheduled maintenances and upgrades. Some travel may also be required depending on circumstances. **Key Responsibilities**: - Application Management:_ - Ensure optimal performance, troubleshoot issues, and drive continuous improvement. - Administrate user credentials,...


  • North York, Canada TORONTO BUSINESS COLLEGE Full time

    Toronto Business College is a private career college that has partnered with an Ontario community college to offer programs to international students in the GTA. Our goal is to provide our students with the theoretical knowledge and practical skills required to thrive in the increasingly dynamic workforce. We strive to offer the most relevant programs and...


  • North York, Canada Ecom Freight Full time

    We are looking for an enthusiastic Business Development Specialist to join our team in Toronto, ON. About us: We are a young fast growing logistics company. We are providing last mile delivery and fulfillment services and working with many giants of the industry already. As we grow, we are looking to attract more businesses our end - and this is where you...


  • North York, Canada Healthy Planet Full time

    **Business Transformation Specialist** The VP Business Information Security Officer (BISO) spearheads strategic technology initiatives to fortify information security, aligning with business objectives. This role focuses on leading agile projects, ensuring compliance, empowering teams, and driving innovation to secure systems and enhance our competitive...


  • North York, Canada Ecom Freight Full time

    We are looking for an enthusiastic Business Development Specialist to join our team in Toronto, ON. **About us**: We are a young fast growing logistics company. We are providing last mile delivery and fulfillment services and working with many giants of the industry already. As we grow, we are looking to attract more businesses our end - and this is where...


  • North York, Canada Nestle Operational Services Worldwide SA Full time

    **Position Snapshot** **Business area**: Nestlé Canada **Location**: North York, ON located at 25 Sheppard Ave W, North York, ON M2N 6S8 (Hybrid) **A little bit about us** While Nestlé is known for KitKat, Gerber, Nescafe, and Haagen-Dazs, our recipe for success comes down to one thing: our people. We strive to lead a people-focused culture that empowers...

  • Business Process

    2 weeks ago


    North York, Canada Hobart Canada Full time

    **Company Information** Hobart is the leading supplier of equipment, systems and service in the food industry. Hobart offers the broadest line of equipment including cooking, food preparation, refrigeration, bakery systems, warewashing and waste systems, and weighing, wrapping and labeling systems. Headquartered in Toronto, Ontario with branch offices in...


  • North York, Canada Rogers Communications Full time

    Our Connected Home team is proud to offer our customers seamless and simple technology that fits into any lifestyle. Our fibre network supports millions of customers with high-speed Internet, TV, and Smart Home Monitoring to keep Canadians connected to the people and things that matter most. We know that our customers rely on us to provide them reliable...


  • North York, Canada Apotex Inc. Full time

    **About Apotex Inc.** **Job Summary**: **Responsibilities**: - Design and implement Mule APIs in MuleSoft Anypoint API platform by documenting and designing REST API's using RAML - Support MuleSoft architecture process including system, process and experience APIs. - Responsible for impact analysis document review, code review and JUnit or MUnit test...


  • North York, Canada Apotex Full time

    About Apotex Inc. Job Summary Job Responsibilities Design and implement Mule APIs in MuleSoft Anypoint API platform by documenting and designing REST API's using RAML Support MuleSoft architecture process including system, process and experience APIs. Responsible for impact analysis document review, code review and JUnit or MUnit test cases. Responsible...

  • Sales Specialist

    2 weeks ago


    North York, Canada Phoenix Marketing Alliance Full time

    Here at _Phoenix_, we firmly believe that a united team with a shared purpose and driven by passion is the cornerstone of any prosperous enterprise! Our unique approach sets us apart from other marketing companies as we prioritize cooperation, respect individual aspirations, and strive to establish a workplace that fosters genuine career satisfaction. As a...


  • North York, Canada Nestle Full time

    **A little bit about us **Nestle is the world’s largest food and beverage company. We have over 2000 brands ranging from global icons to local favorites and are present in 190 countries worldwide. In Canada, excelling means sharing our passion for our purpose of enhancing quality of life and contributing to a healthier future. It also means living up to...