CLAIMS ASSESSOR

---

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'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!

---

About the job

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.

---

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/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.

---

Additional information:

Note:

• The number of positions to be filled has not been identified at this time. This competition will be used to create an eligibility list of qualified candidates to fill upcoming opportunities within the next eighteen months following the closing date of the job ad posting.
• In accordance with the Ontario Public Service (OPS), Employment Screening Checks Policy (ESCP), the top candidate(s) may be required to undergo a security screening check. Refer to the above to determine the screening checks that are required for this position.
  
  Required security screening checks along with your written consent, will be sent to the Transition and Security Office (TSO), Talent Acquisition Branch (TAB), HR Service Delivery Division (HRSDD) to evaluate the results. If applicable, the TSO, with your written consent, will request and obtain any additional employment screening checks that were not obtained directly by you.
  
  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 employment 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 employment screening check(s) will be considered in specific relation to the duties and responsibilities of the position being filled. Employment screening check records will be maintained by the TSO and kept strictly confidential.
• The information that you provide for the purpose of this competition and the results from this competition may be used to fill other positions. These positions may be of various tenures including short-term assignments. Your information and the results from this competition will be retained for the purpose of filling vacancies in accordance with the applicable collective agreement or policy provisions.

---

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.