Claims Specialist

Job Title: Claims Specialist:

Location: Edmonton, AB

Employment type: Contract

Duration: 12 months

Job Description:

This position focuses on completing work in the following core areas:

• Coordination and completion of pre-payment quality assurance and post payment verification processes for claim, and adjustments to ensure accuracy of submitted claims and issued payments;
• Investigation and resolution of complex customer service inquiries and technical issues related to claim, claim payments, claim advance and child registration;
• Recommending enhancements to the information system and coordinating testing plan and activities for the system;
• Coordinating, monitoring and reporting on the recovery activities;
• providing input on and drafting policy and training products aimed at both internal and external audiences, and
• Supervision of claim payment coordinators.

RESPONSIBILITIES AND ACTIVITIES

1. Support Childcare Providers

As one of the client Claims Unit key contacts and representatives, the Claims Specialist is guided by program and financial policies. The claims specialist applies a comprehensive body of knowledge of claims and associated child care program areas, their training and experiences to contribute to the effective and efficient administration of child care claim system. This will include providing advice, clarification and interpretation relating to operations, technology and program policy.

More specifically, the Claims Specialist will be responsible for managing (by email, telephone and correspondence such as Action Requests) customer service issues such as:

• complex claims/adjustments questions and issues from childcare providers;
• problem solving childcare providers' online submission errors for claims;
• resolving customer complaints and issues associated with claim, claim advance and adjustment payments.

The position applies sound investigative and analytical skills when facilitating the resolution of these issues. The claims Specialist must have a full understanding of the impact of its role and decision-making on the work of others, both internally and externally.

• 2. Ensures Payment Accuracy
  Monitors the system generated quality assurance reports prior to the release of childcare claims for expenditure officer approval.
• Coordinates and monitors post payment verification process and reports on the progress and outcomes;
• Identifies any cases where errors or fraud may have occurred in the submission of a childcare claim.
• Reports on program internal controls, system gaps and risks.
• Prepares reports on claims activity using Ministry's reporting and information systems. These may include: number of clients, client profile, etc.
• identifies business information needs for inclusion into systems to support administration and management of claims.

3. Coordinate and Monitor Grant Funding Recoveries

Claims Specialist is responsible for maintaining the process of collecting timely repayments from childcare providers whom the department has identified as owing funds back to the Ministry. This includes activities such as:

• setting up tracking tools and maintaining up-to-date records on existing recovery cases,
• drafting and issuing the repayment requests to childcare providers,
• coordinating timely follow-up activities for overdue repayments,
• escalating complex repayment issues to Supervisor,
• Reporting on the recovery progress, stats and outcomes.

4. Supports Information System Functionality

Position assists in identifying opportunities for re-engineering, streamlining or enhancement of business processes.

Claims Specialist will be responsible for the development of testing scripts and coordination of testing resources for any enhancements done to the information system.

5. Supervision

The Claims Specialist may be assigned the supervisory duties as determined necessary by the Program Consultant - Claims or Manager Provincial Program. The duties may include onboarding and training of the new claim payments coordinator staff, assigning tasks and managing workloads, monitoring performance and identifying haps in knowledge and training required.