Business Application Specialist

1 month 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:

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