System Technical Specialist

2 weeks ago

North York, Canada One Team Health Full time

One Team Health is currently seeking seeking a knowledgeable and dedicated System Technical Specialist to join our dynamic team.

The System Technical Specialist plays a critical role in supporting the health claims system by troubleshooting complex system issues, maintaining system integrity, and ensuring accurate configuration of healthcare plans.

This role requires a deep understanding of claims processing, healthcare policies, and system functionalities to optimize processes, implement system enhancements, and support end users through training and issue resolution. They will also collaborate with stakeholders to improve efficiencies, conduct user acceptance testing and assist with third-party claims and audits.

**PRIMARY DUTIES AND RESPONSIBILITIES**:

- Provide advanced support to claims users by troubleshooting and resolving complex system issues within the health claims system.
- Knowledge of Health Claim Administration System, preferably with Quantum Choice (QC)
- Maintain a system log of the problems reported to monitor system inadequacies/improvements
- Update and maintain various system tables, files and claims data
- Knowledge of configuration and building of health care plans such as Benefit Contracts, Benefit Plans, Grouping of CPT & HCPCS procedure codes.
- Develop an in-depth understanding of the business areas and the health care system in order to advise on how the health care system can be used better, review and document existing business processes and suggest and implement improvements and enhancements.
- Knowledge of Health Care Policies and Procedures such as co-Insurance, accumulators, policy maximums and re-imbursements.
- Ongoing user acceptance testing to ensure the integrity of the data as required. Responsible for the ongoing user acceptance testing of calc codes, system releases on the Health Claims System and the testing of various system problems submitted by the claims user.
- Audit and Maintain Integrity and accuracy
- Required to work with specialists regarding new benefits, pricing and renewals
- Training staff in the Health Claims system procedures
- Assist management with third-party claims and prepare third party recovery and subsidy reimbursement claims
- Request and review daily audit reports
- Perform other duties and projects assigned by Senior Management

**REQUIREMENTS**:

- Minimum 5 years of experience in the employee benefits insurance industry, with a strong focus on health claims processing and system administration
- Extensive knowledge of systems related to the administration and claims adjudication of employee benefits, including benefit contracts, plan structures, and claims reimbursement policies
- Exceptional problem-solving skills, with the ability to identify system inefficiencies and implement process improvements

**SKILLS / ATTRIBUTES**:

- Professional interpersonal skills for internal team interaction
- Ability to interact diplomatically with external clients and partners
- Excellent organizational and time management skills
- Strong problem-solving, analytical and decision-making skills
- Strong communication skills, both oral and written
- Attention to detail

Schedule:

- Monday to Friday

Work Location: Hybrid remote in North York, ON M2J 4Y1

Application deadline: 2025-03-11

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