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Claims Adjudicator

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Edmonton, Canada Government of Alberta Full time

**Job Information**

Job Requisition ID: 66731
Ministry: Health
Location: Edmonton
Full or Part-Time: Full Time
Hours of Work: 36.25 hours per week
Permanent/Temporary: Permanent

Number of vacancies: Multiple vacancies
Scope: Open Competition
Closing Date: March 6, 2025
Classification: Administrative Support 6

**Salary**: $2,073.50 to $2,549.41 bi-weekly ($54,118 - $66,539/year)

The Ministry of Health is building a more resilient and sustainable health care system that can support Albertans getting care when and where they need it, while responding to system-wide health challenges, improving health outcomes and maintaining fiscal responsibility. The ministry supports Albertans’ health and well-being throughout their lives by protecting public health and promoting wellness; coordinating and delivering safe, person-centered, quality health services; planning capital infrastructure; supporting innovative information management and technologies; regulating health care; and funding the health system.

The Health Insurance Programs Branch (HIP) is responsible for administering the Alberta Health Care Insurance Plan (AHCIP) in compliance with Alberta and Canadian legislation and policy. This includes the registration of eligible Albertans; Alberta practitioners and facilities; payment of claims to Alberta practitioners and residents; and special out of province/country programs for Albertans seeking access to medically required health services not available in Alberta and /or Canada.

**Role Responsibilities**:
The Claims Adjudicator acts as a direct resource of information to over 10,000 practitioners and all Alberta registrants for insurable or non-insured medical benefits and claims information. This position will be cross-trained on all aspects of managing claims and will be heavily involved in adjudicating medical and hospital claims, assessing highly complex surgical procedures that are received with supporting documentation, extensively researching and handling responses to various correspondence received from both service providers and the general public.

As the Adjudicator;
- You will have sound medical terminology, knowledge of the Alberta Health Care Insurance Act, Regulations, Policy and Procedures including the Schedule of Medical Benefits (SOMB).
- Your drive for results will ensure that you accurately process claims by identifying and interpreting insured and non-insured benefits based on the SOMB. With creative problem solving, you will identify and investigate problematic claims to determine the appropriate resolution.
- You have strong communication skills and the ability to develop networks to effectively communicate with external stakeholders who may be affected by the assessment of claims, including Alberta residents, secondary insurance companies, other health plans, physicians, hospitals and other service providers.
- With systems thinking in mind, you will ensure that you are up to date with new legislation, polices and procedure relating to claim submissions and benefits to ensure accuracy and efficiency when processing claims.

Please

**APS Competencies**:
Competencies are behaviors that are essential to reach our goals in serving Albertans. We encourage you to have an in depth understanding of the competencies that are required for this opportunity and to be prepared to demonstrate them during the recruitment process.

This link will assist you with understanding competencies:

- **Agility** - Proactively incorporates change into processes, Creates opportunities for improvement Is aware of and adapts to changing priorities. Remains objective under pressure and supports others to manage their emotions, Proactively explains impact of change on roles, and integrates change in existing work. Readily adapts plans and practices.
- **Drive for Results** - Works to remove barriers to outcomes, sticking to principles, Forecasts and proactively addresses project challenges. Removes barriers to collaborate and achievement of outcomes. Upholds principles and confronts problems directly. Considers complex factors and aligns solutions with broader organization mission.
- **Systems Thinking** - Takes a long-term view towards organization's objectives and how to achieve them. Takes holistic long-term view of challenges and opportunities. Anticipates outcomes and potential impacts, seeks stakeholder perspectives. Works towards actions and plans aligned with APS values.
- **Creative Problem Solving** - Works in open teams to share ideas and process issues. Uses wide range of techniques to break down problems. Allows others to think creatively, voice ideas and brings the right people together to solve issues.
- **Build Collaborative Environment** - Involves a wide group of stakeholders when working on outcomes. Involves stakeholders, shares resources and positively resolves conflict through coaching and facilitated discussion. Uses enthusiasm to motivate and guide others. Acknowledges and works with d