CLAIMS ASSESSOR

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Your strong administration, research and analytical skills are in demand! In this exciting opportunity, the Ministry of Health and Long-Term Care is looking for someone with those very skills to join a dynamic team that provides excellence in processing medical claims for Ontarians.

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About the job

You will:

•Use your research skills to assess claims and analyze payment irregularities
•Respond to inquiries
•Initiate payments, adjustments or recoveries
•Prepare legal and executive summaries
•Provide service to medical providers and the public
•Deal with confidential and sensitive medical and personal information

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What you bring to the team

KNOWLEDGE:

• Proven ability to read and understand reports and compare information and supporting documentation to ensure correct assessment and/or payment.
• 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/ANALYTICAL SKILLS:

• Ability to evaluate and adjudicate stakeholder claims.
• Ability to determine appropriate payment.
• Proven ability to apply discretion and judgment 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) 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 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.

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Additional information:

Note:

• In accordance with the Ontario Public Service Employment Screening Checks Policy, the top candidate(s) may be required to undergo a security screening check. Please refer to the Additional Information / Address section above to determine the screening checks that are required for this position.
  
  You will be responsible for obtaining the criminal record check at your own expense and provide it, along with your written consent, to the Transition and Security Office (TSO), HR Service Delivery Division to evaluate the results. If applicable, the TSO, with your written consent, will request and obtain any additional screening checks as indicated in the Additional Information / Address section above that were not obtained directly by you. (Note: If a Vulnerable Sector Screening/Check is required, it must also be obtained in person at your local police service.)
  
  A record under the Criminal Code and/or other federal offence record(s) does not automatically mean you will be ineligible for the position. The screening check(s) will only be reviewed and evaluated by the TSO for the purpose of making a security clearance decision. The details of an individual's screening check(s) will be considered in specific relation to the duties and responsibilities of the position being filled. Screening check records will be maintained by the TSO and kept strictly confidential.
• N-HL-108214/17

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Language requirements and assessment:
All external Ontario Public Service (OPS) job ads are posted in English and French. Check the "position(s) language" section at the top of each job ad for the language requirements. For all roles, candidates are assessed in English, the business language of the OPS. If the position is bilingual (English/French), you'll also need to pass a French-language proficiency test.

Exigences en matière de langue et évaluation:
Toutes les offres d'emploi externes de la fonction publique de l'Ontario (FPO) sont affichées en français et en anglais. Consultez la section « Langue du ou des postes » en haut de chaque offre d'emploi pour connaître les exigences linguistiques. Pour tous les postes, les candidats sont évalués en anglais, la langue d'affaires de la FPO. Si le poste est bilingue (anglais/français), vous devrez également passer un test de compétences linguistiques en français.