Claims Representative

2 months ago

Winnipeg, Canada Manitoba Blue Cross Full time

About Manitoba Blue Cross
We’re a Manitoba-based, not-for-profit, health benefits provider with a vision to be the trusted and essential health and wellness partner for all Manitobans. Every dollar made is reinvested in our infrastructure, our people, and our province with the goal of providing better care for our members, expanding our community impact and broadening our health care knowledge.
Why work for us?
Manitoba Blue Cross, is a Manitoba Top Employer. We are empowered to give back to the community, and we know that caring needs to start in our workplace with our own Manitoba Blue Cross team. We actively foster a culture that focuses on your satisfaction, development, diversity, and growth.
Culture of Caring
We strive to succeed at reaching our organizational goals, but we always make time to celebrate our successes. Having fun as a group and rewarding our employees for their accomplishments is an essential part of our workplace culture.
We want our workforce to reflect the diverse community we serve, and we're committed to creating a fair and respectful workplace. We offer a work environment that promotes a healthy work-life balance and support to advance your career that includes:

- Competitive starting salary.
- A comprehensive health benefit package.
- Hybrid work environment, flexible work schedules.
- Fully equipped onsite fitness center.
- Casual dress code to promote diversity and inclusivity.
- Personal and professional development.

Are you a driven, dedicated, and enthusiastic individual who wants to work in a friendly and rewarding environment? If so, we are looking for someone like you The following position is open to anyone residing in Winnipeg and surrounding areas with valid work authorization.

The Claims Representative assesses, adjudicates and processes standard and diverse Health Spending Account and Hospital and Dental benefit claims in an accurate and timely manner. The incumbent must work well independently as well as in a team setting.
DUTIES AND RESPONSIBILITIES
- Adjudicates and processes standard and diverse Health Spending Account, Ambulance and Hospital, Extended Health, Prescription Drug, Vision and Dental claims in accordance with performance standards
- Communicates with members and providers during the course of claims assessment.
- Adjudicates and processes pre-calculated claims with non-standard procedures.
- Adjudicates and processes preauthorized claims.
- Adjudicates and processes claims for coordination of benefits.
- Assists in the management of the Claims Workplace as assigned.
- Assist with adjudication of medical claims.
- Processes claims for groups with Service Level Agreements within the standards set out in the agreement.
- Returns claims for completeness of information and obtains any necessary additional information from both members and providers.
- Assists members and providers regarding claiming procedures.
- Responds to customer inquiries, particularly those of a complex nature.
- Processes bonds and returned cheque requests.
- Manages and updates Coordination of Benefits (COB) information received from Information/Customer Services and Client Administration.
- Maintains production report and weekly claim count.
- Performs other related duties as assigned.

QUALIFICATIONS AND SKILLS
- Dedicated to the principles of exceptional service; committed to responding to, anticipating and addressing customer needs for both internal and external customers. Capable of communicating effectively with subscribers and providers in a professional manner.
- College Diploma or equivalent combination of education and 1-2 years’ related experience.
- Strong problem solving, analytical and numerical abilities.
- Excellent interpersonal and communication skills.
- Excellent organizational skills with the ability to manage and prioritize several activities on an ongoing basis.
- Ability to work independently as well as in a team setting.
- Previous claims adjudication experience and/or experience in the health field an asset.
- Knowledge of pharmacy and medical products, dental and their terminology an asset.
- Completion of medical administrative assistant certificate courses an asset.
- Overtime may be required during peak periods
- Capable of completing industry education programs entailing a self-directed study and the writing of graded examinations. Specific programs include but are not limited to LOMA, CEBS and ICA. Enrollment in, and completion of, such courses will be encouraged.

Ready to Apply? We are excited to meet you
We thank all applicants for their interest; however only those being considered will be contacted.
Manitoba Blue Cross is committed to the principles of diversity, equity & inclusion and to promoting opportunities in hiring for everyone. We want our workforce to reflect the diverse community we serve, and we're committed to creating a fair and respectful workplace.

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