Do you have an interest in providing timely, accurate and cost effective delivery of claim services to health care providers and the public in support of the Ministry of Health and Long-Term Care's health care delivery strategies? If so, bring your knowledge of medical terminology, human anatomy and your ability to authenticate, adjudicate and facilitate payment of claims for health care benefits to our team!What can I expect to do in this role?You will:•Use your research skills to assess claims and analyze payment irregularities within strict deadlines.•Respond to inquiries.•Initiate payments, adjustments or recoveries.•Provide service to medical providers and the public.•Deal with confidential and sensitive medical and personal information.How do I qualify?KNOWLEDGE:• Demonstrated knowledge of medical terminology and human anatomy to read and understand operative and emergency reports.• Proven ability to understand, interpret and apply policies, work within guidelines, procedures and legislation to process claims and protect information and determine its disclosure.RESEARCH AND ANALYTICAL SKILLS:• Ability to evaluate and adjudicate stakeholder claims. • Ability to determine appropriate payment.• Proven ability to apply discretion and judgement to confirm eligibility for programs, determine when to escalate contentious issues/claims and adjudicate payment as applicable.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.• Working knowledge of personal computers, mainframe applications, software (e-mail, word processing, internet, databases) and keyboarding skills to input/access/retrieve information and create correspondence and reports.
Job advertisements for positions that have been designated bilingual will be provided in both English and French on the website. Positions that are not designated bilingual are not translated and are displayed in English only on both the English and French versions of the website.
Les annonces d'emploi pour les postes désignés bilingues sont publiées en anglais et en français sur le site Web. Les annonces pour les postes qui ne sont pas désignés bilingues ne sont pas traduites et elles figurent en anglais seulement, tant dans la version française que dans la version anglaise du site.
The Ontario Public Service is an inclusive employer.
Accommodation is available under the Ontario Human Rights Code.
Note: The only website where you can apply on-line for positions with the Ontario Public Service is http://www.gojobs.gov.on.ca
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Queen's Printer for Ontario, 2007
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