Medical Claims Specialist

2 days ago


Ottawa, Ontario, Canada People Corporation Full time

Job Summary

We are seeking a highly skilled Medical Claims Specialist to join our team at People Corporation. As a Medical Claims Specialist, you will play a critical role in processing group plan member health claims, responding to inquiries, and performing administrative duties.

Key Responsibilities

  • Process group plan member health claims by applying established policies and procedures.
  • Respond to written, electronic, or in-person inquiries related to claims, benefits payable, and general group plan policies.
  • Perform other related administrative duties, including data entry, verification of eligibility, and claims payments.
  • Liaise with medical professionals and provide accurate and timely information to members and clients.
  • Verify eligibility of members, drugs, services, providers, co-insurance, deductibles, payments, and procedure/dental codes.
  • Produce claims payments, including applying applicable deductibles.
  • Interpret policies and administrative practices and correctly apply them in the adjudication of claims.
  • Maintain electronic data and document systems, including scanning, faxing, filing, destroying, photocopying, and data entry.
  • Verify work and data for accuracy and completion.
  • Prioritize work to ensure effective time management.
  • Maintain procedure manuals and document new procedures and updates.

Requirements

  • A good vocabulary of medical terminology.
  • Sound knowledge in the concept of group or individual benefits administration.
  • Sound knowledge of Microsoft Office and standard office administration procedures.
  • The demonstrated ability to learn and master new software and technology.
  • The ability to extract and interpret or simplify information from various technical sources.
  • Strong mathematical and organizational skills, the ability to prioritize and multi-task, and the ability to manage time effectively.
  • The ability to adhere to existing company policies and procedures.
  • The ability to use tact and discretion to maintain information in the strictest of confidence.

What We Offer

  • Competitive compensation.
  • Extended health care and dental benefits.
  • A retirement savings plan with company contributions.
  • A suite of Health & Wellness offerings.
  • Mental Health programs and support for you and your family.
  • Assistance for the completion of industry designations.


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