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Toronto, Ontario, Canada Healthcare Insurance Reciprocal of Canada (HIROC) Full timeAbout Us: Healthcare Insurance Reciprocal of Canada (HIROC) is a trusted healthcare safety advisor, committed to offering a full spectrum of insurance, risk and claims management products and support.
Healthcare Claims Specialist
2 months ago
This position entails the adjudication of Non-Insured Health Benefit Dental Claims for indigenous people in Canada. As a Claims Processor, you will be responsible for registering, reviewing, validating, and adjudicating claims on a daily basis.
Key Responsibilities:
- Registers, reviews, validates, and adjudicates claims on a daily basis as per processes to meet minimum accuracy Service Level Standards.
- Monitors and handles pended claims to ensure they are settled according to the Service Level Standards.
- Return Claims that are missing mandatory client/benefit information as per using either claim entry or the doc reg screen and entering reason for the return. Address envelopes and attach provider return letter to claim and have clerical department send out all returns same day.
- Claim Adjustments that are given to processors by call centre/Supervisor/Senior Processors/QA Analyst due to errors are scanned and reviewed to ensure an error has been made, once a claim is adjusted, the information is fed back to call centre to be logged as complete.
Requirements:
- Experience with data entry, excellent accuracy.
- Experience working in an operational setting an asset.
- Experience in the group health insurance industry an asset Strong focus on customer service is required.
- Ability to work effectively in a fast-paced, rapidly changing environment.
- Excellent organizational and interpersonal skills.
- Ability to work within a team.
- Working knowledge of Microsoft Office Suite of Tools (Word, Excel, Outlook).
- Ability to work or interpret data independently.
This is a 3-month contract position. It will be a condition of employment that the successful candidate obtains an Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation to receive clearance if required.
