Job Specification

Purpose of Position :

To respond to a variety of phone and written inquiries received from the general public, benefit recipients, vendors, caseworkers and other stakeholders related to centralized social assistance services and benefits offered by the ministry. To assess, validate and process invoices and applications for
benefits in a customer service oriented environment, search and update social assistance databases, resolve discrepancies, transcribe case summaries and medical information, and refer fraud allegations to case workers and managers in local offices across the province.

Duties / Responsibilities :

Position functions within Social Assistance Central Services which is responsible for providing call centre services, invoice claims and benefit application processing, mail distribution, and program assistance to the public, recipients, local offices and stakeholders regarding claims assessment
and program policies. Within this context the position:
1. Receives, researches and responds to telephone (automated call distribution system) and written enquiries from the general public, benefit recipients, vendors and other stakeholders related to benefit payments (e.g., Vision Care), discrepancies and adjustments; social assistance fraud reporting line;
client verification line for federal, provincial and municipal stakeholders; and the First Nation verification line. Explains rules and processes relating to social assistance benefits, services, invoice submissions and payments. Completes intake process for new requests, validates data and enters case specific details into benefits assessment system for payment. Reviews invoices for eligibility and accuracy, and interprets and applies established policies, procedures and guidelines.

2. Assesses and resolves payment errors, recalculates allowable amounts, and conveys resolution verbally or in writing; searches databases; documents findings; and identifies and refers issues requiring further action or investigation. Redirects requests for benefits identified as exceptional; seeks clarification from case workers and/or vendors to optimize service delivery. Accesses and updates database, and prepares correspondence and reports.

3. Receives, reviews and responds to correspondence regarding allegations of abuse or misuse of program benefits, received by mail, fax or email i.e., from the public, other levels of government or jurisdictions, other agencies, social housing, etc. Searches, verifies and logs allegation data into database; assesses the validity of allegations received and refers to local office or program area manager for investigation.

4. Prepares and transcribes case summaries outlining the facts of benefits issues or fraud allegations, including sensitive information and pertinent documentation of evidence filed, and forwards to local office for detailed investigation and review by external consultants.

5. Redacts information for FIPPA requests related to benefits applications and appeals. Summarizes case details provided in medical assessments, including redacting information to ensure privacy and objectivity can be maintained when exchanging information with medical consultants. Prepares decision letters for review and signature by management; and prepares correspondence that may be subject to external review and/or appeal at tribunal proceedings.

6. Prepares case summaries outlining factual details pertaining to exceptional benefit requests in order to document relevant special circumstances for review and consideration by case workers prior to processing.

7. Continually updates social assistance databases to ensure up-to-date, accurate and accessible information necessary to support decisions related to the disposition of benefits.

8. Maintains and updates hard and soft copy filing systems; coordinates records archival, retention and retrieval services; participates in operational training activities; and updates process/procedural manuals.

9. Performs other program related tasks such as: distributing and processing mail, preparing and generating statistical reports, ordering supplies, ensuring physical security of documents, and providing input into proposed changes to procedures/operations.

Staffing and Licensing :

Word processing and database proficiency required and utilized on a regular basis.

Knowledge :

Role and mandate of the branch, administrative/office procedures, directives and guidelines pertaining to social services and assistance, and relevant sections of the Ontario Disability Support Program Act and Ontario Works Act to interpret and apply established procedures, and respond to enquiries
from the general public, benefit recipients, vendors and other stakeholders regarding social assistance payments, benefits, eligibility, services, processes, procedures and fee schedules.
- Knowledge of income support, benefits, claims, payment entitlements, fee schedules, invoicing procedures and cut-off dates, to assess and determine invoice payments, compose correspondence in response to inquiries, resolve errors and discrepancies, and to refer suspected fraud issues.
- Knowledge of the Freedom of Information and Protection of Privacy Act to avoid the inadvertent release of confidential client information.
- Fully programmable word processing software, in-house program software, and database and spreadsheet applications to prepare correspondence, memoranda, summaries and reports; access clients' files; update and maintain social assistance databases; and generate reports, tables and databases. (MS Word, Outlook, Excel)

Skills :

- Analytical skills to apply fee schedules, assess and validate invoices, identify anomalies, perform corrections, resolve billing/payment errors, conduct follow up or refer enquiries requiring investigation.
- Reasoning and problem-solving to identify and correct errors and discrepancies by verifying fees payable, recalculating invoice/payment amounts, and applying established administrative procedures and guidelines.
- Mathematical skills to check invoices, recalculate fees and adjustments, and explain under/overpayments.
- Attention to detail to log mail, and record enquiries and invoices for statistical purposes, to identify and rectify errors, and consistently apply established procedures.
- Organizational skills to prioritize own workload and complete tasks within set timeframes.
- Oral and written communication skills to explain payment policies and processes to clients by phone or in writing, to compose responses to recipients, and record case summaries for staff.
- Interpersonal skills and diplomacy to question billing irregularities and invoice submissions with clients, and to respond with empathy to clients conveying sensitive, personal information.
- Courtesy to respond to general telephone enquiries regarding program delivery and services.
- Word processing and data entry skills to produce routine correspondence and summary reports.

Freedom of Action :

Work is performed with minimal direct supervision by the Manager, and in accordance with relevant legislation, policies, procedures, guidelines, fee schedules and established administrative methods.
Decision-making includes: providing customer service to callers and clients consistent with OPS standards; applying and explaining the intent of policy concerning benefits and payments in response to enquiries from the general public, benefit recipients, vendors, local officer staff and managers, and/or
other stakeholders; determining confidentiality of information when responding to enquiries; independently identifying errors and resolving transaction discrepancies; determining enquiries or issues requiring referral for resolution; and prioritizing work to meet deadlines.
The position is expected to resolve routine problems and to refer contentious, complex or unusual problems not covered by established procedures or guidelines to the Manager.