Indigenous Claims Processor
2 weeks ago
**Description**:
Our partner and client, Express Scripts Canada, administers on behalf of Health Canada Claims Adjudication. This role entails adjudicating Non-Insured Health Benefit Dental Claims for Indigenous people in Canada.
The role of a Claims Processor is to register, review, validate, and adjudicate claims on a daily basis ensuring data integrity in the system. Claims Processors are responsible for processing Pay Provider, Pay Client and Client Reimbursement claims for all regions and are responsible for ensuring all pended claims are processed within the standard turn-around time.
This role is instrumental in meeting our Claims Processing Service Levels which contributes to customer satisfaction and minimizes risk of financial penalties.
**Key Responsibilities**:
- Register, review, validate, and adjudicate claims on a daily basis as per processes documented in the APM
- Monitor and handle pended claims to ensure they are settled according to the Service Level Standards
- Prepare and send a Dental Provider Missing Information Return Form based on the requestor’s communication preference (mail or fax) and language preference for claims with missing or illegible data
- Consistently meet the minimum accuracy standards of 98%
- Consistently meet the productivity standards for assigned quotas within the established Service Delivery Standards
- Participate in frequent quality and productivity touchpoints
- Engage in bi-weekly claim department and monthly benefit process meetings
- Handle claim adjustments that are provided from various departments
**Qualifications**:
- 1+ years’ experience with data entry with proven records of excellent accuracy
- Experience working in an operational setting an asset
- Experience in the group insurance industry an asset Strong focus on customer service is required
- Quick learner and ability to make decisions with mínimal supervision
- Strong analytical skills and ability to work or interpret data independently
- Self-motivation, determination and ability to work effectively in a fast paced, rapidly changing environment
- Excellent time management, organizational and interpersonal skills
- Working knowledge of Microsoft Office Suite of Tools (Word, Excel, Outlook)
**Physical Demands/Working Conditions**:
- Office and Call Center environment
- No heavy lifting
- Intermittent walking within the Claims Department for Team support
- Comfortable work stations
**Benefits of Working with FCH**:
- Inclusive work environment
- Generous Group Benefits with Pension
- Generous PTO
- Team culture
**Job Types**: Full-time, Permanent
**Salary**: $38,000.00-$41,000.00 per year
**Benefits**:
- Casual dress
- Company pension
- Dental care
- Disability insurance
- Employee assistance program
- Extended health care
- Life insurance
- Paid time off
- Vision care
Schedule:
- Monday to Friday
Supplemental pay types:
- Overtime pay
Ability to commute/relocate:
- Toronto, ON: reliably commute or plan to relocate before starting work (required)
**Experience**:
- Indigenous Cultural Knowledge: 7 years (preferred)
Work Location: In person
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