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Healthcare Claims Processing Specialist
3 months ago
Position Overview
We are looking for a Healthcare Claims Processing Specialist to become a vital part of our team at People Corporation.
The role of the Claims Processing Specialist involves managing group plan member health claims by adhering to established guidelines and protocols. This position requires responding to inquiries related to claims, benefits, and general group plan policies through various communication channels, while also performing other administrative tasks as needed.
Key Responsibilities:
- Providing prompt, efficient, and courteous responses to clients, members, and external contacts.
- Drafting correspondence using standardized templates for members, carriers, or clients.
- Delivering accurate and timely information regarding coverage, claims processing, and benefits.
- Notifying management of any issues encountered during daily operations.
- Collaborating with healthcare professionals as necessary.
- Conducting data entry related to claims and member communications.
- Verifying member eligibility, including drugs, services, providers, co-insurance, deductibles, payments, and procedure codes.
- Ensuring accuracy and completeness of cheques, letters, forms, and reports.
- Processing claims payments while applying relevant deductibles.
- Interpreting and applying policies and administrative practices in claims adjudication.
- Maintaining electronic data and documents, including scanning, filing, and data entry.
- Verifying work and data for accuracy and completeness.
- Prioritizing tasks to ensure effective time management.
- Updating procedure manuals and documenting new processes.
Qualifications:
- Familiarity with medical terminology.
- Strong understanding of group or individual benefits administration.
- Proficiency in Microsoft Office and standard office procedures.
- Ability to learn and adapt to new software and technology.
- Skill in extracting and interpreting information from various technical sources.
- Strong mathematical and organizational skills, with the ability to prioritize and manage time effectively.
- Commitment to adhering to company policies and procedures.
- Ability to maintain confidentiality and use discretion.
Preferred Skills:
- Excellent communication skills in both English and French.
- Ability to foster positive public relations within and outside the organization.
Benefits:
- Opportunity to learn from industry experts.
- Comprehensive health and dental benefits.
- Retirement savings plan with employer contributions.
- Health & Wellness programs.
- Mental health support for employees and their families.
- Assistance in obtaining industry designations.
- Competitive salary package.
At People Corporation, we are dedicated to helping businesses thrive. As a national provider of benefits, retirement, wealth, wellness, and human resource solutions, we serve over 20,000 clients and nearly 3 million Canadians with tailored solutions to meet their unique needs.
About People Corporation:
We are committed to providing an inclusive and accessible environment where all employees and clients feel valued and respected. Our goal is to build a diverse workforce that reflects the communities we serve, ensuring every employee has the opportunity to reach their full potential.