Claims Assessor

**Claims Assessor**:
**Job ID**:

- 231013

**Posting status**:

- Open

**Organization**:

- Ministry of Health

**Division**:

- Ontario Health Insurance Plan Division/Claims Services Branch

**City**:

- Oshawa

**Position(s) language**:

- English

**Job term**:

- 1 Temporary assignment/contract up to 12 months with possible extension

**Job code**:

- 09OAD - Office Administration 09

**Salary**:

- $28.14 - $32.82 Per hour*
*Indicates the salary listed as per the OPSEU Collective Agreement.

**Join our team as a Claims Assessor**

Are you passionate about making a difference in the healthcare sector? Do you thrive on providing timely, accurate, and cost-effective services? If so, we have the perfect opportunity for you

As a Claims Assessor, you'll play a crucial role in supporting the Ministry of Health's healthcare delivery strategies. You'll utilize analytical and research skills and medical knowledge to authenticate, adjudicate, and facilitate the payment of claims for Ontario healthcare benefits. Our office is located in the heart of the city's vibrant Little Italy district, surrounded by some of the best Italian restaurants and cafés—perfect for a delicious lunch break or after-work bite.

What We Offer:

- A dynamic and supportive work environment
- Opportunities for professional growth and development
- The chance to make a real impact on the lives of Ontario healthcare providers and the public

Bring your skills and passion to our team and help us deliver exceptional claim services. and be part of a mission that truly matters**About the job**: You will:

- Use your research skills to assess claims and analyze payment irregularities within strict deadlines.
- Respond to complex inquiries such as billing irregularities, payment discrepancies, etc.
- Initiate payments, adjustments or recoveries.
- Provide service to medical providers and the public.
- Deal with confidential and sensitive medical and personal information.

**What you bring to the team**:
**Knowledge**:

- Demonstrated knowledge of medical terminology and human anatomy to read and understand operative and emergency reports.

**Research and Analytical Skills**:

- Ability to evaluate and adjudicate stakeholder claims.
- Ability to determine appropriate payment.

**Organizational Skills**:

- Ability to organize and manage own workload, process a high volume of claims and inquiries within strict timeframes.

**Tact, Diplomacy and Communication Skills**:

- Demonstrated ability to provide detailed and understandable explanations (oral and written) on work processes and claims payments to internal and external clients.
- Demonstrated interpersonal skills to interact with clients and team members and to understand and respond appropriately to issues, dealing with conflict situations and/or with sensitive medical/financial information.
- Demonstrated experience working cooperatively in a team to meet deadlines and organization goals and assisting in the training of new and existing employees.

**Mathematical and Computer Skills**:

- Ability to calculate fees, recognize billing irregularities and reconcile payments and adjustments.**How we support diversity, inclusion and accessibility**: We are building an inclusive workforce that reflects the communities we serve. We encourage everyone interested in working with us to apply, including people with disabilities, Indigenous, Black and racialized individuals, as well as people from all ethnicities, cultures, sexual orientations, gender identities and gender expressions.

Our hiring process is accessible, consistent with Ontario's _Human Rights Code_ and the _Accessibility for Ontarians with Disabilities Act, 2005._ We are working to prevent and remove barriers in our hiring processes and can offer accommodation to address specific needs related to Code-protected grounds such as disability, family status and religion. For more information about accommodation during the hiring process please contact us.

Learn more about the work the OPS is doing to create an inclusive, anti-racist, accessible and diverse workplace:

- diversity, equity and inclusion initiatives
- accessibility
- Anti-Racism Policy

**What we offer**: The Ontario Public Service is one of Ontario's largest employers. Employees work for a wide range of ministries, with offices in more than 70 cities across the province. We offer:

- a career that can grow across ministries and job functions
- flexible learning and developmental opportunities, including education and mentorship programs
- many employee networks offering support for and education about underrepresented groups
- tailored work arrangements, including opportunities like flex hours, self-funded leave and more

Our comprehensive compensation and benefits package includes:

- a defined-benefit lifetime pension plan (guaranteed, ongoing inflation-protected income after retirement)
- group health, dental, life and disability benefits
- a range of vacation and leave