Join Our Dynamic 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.
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. Apply now 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.
• 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 respond to 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.
Don't meet every qualification?
If you are excited about this position and meet most, but not all, of the listed qualifications, please still consider applying. We recognize that no one person might have every qualification in this job ad, and you just might be the right candidate!
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:
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
• a comprehensive compensation and benefits package
• base salary that aligns to market trends with performance-based pay and scheduled salary progression
• a modern, friendly and accessible physical work environment