Claims Assessor Bilingual (English-French)

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Join Our Sudbury 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. Our office is located in Sudbury's downtown core, surrounded by a variety of local cafés and restaurants to enjoy during lunch breaks or after work.

We Offer:
• on-the-job training to ensure you are successful in the role
• 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

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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 and payment discrepancies
• initiate payments, adjustments or recoveries
• provide service to medical providers and the public
• work with confidential and sensitive medical and personal information

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What you bring to the team

Mandatory Requirement:

• You must be proficient in English and possess oral French language skills at the advanced level. Your proficiency level will be confirmed before hire.

Knowledge:

• knowledge of medical terminology and human anatomy to read and understand operative and emergency reports in English and French
• 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
• 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

Communication Skills:

• ability to clearly explain work processes and claims payment decisions to internal and external clients in English and French
• 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
• 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 computer systems and software (such as email, word processing tools, databases, and online applications) to manage information and prepare correspondence and reports.

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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!

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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:

• diversity, equity and inclusion initiatives
• accessibility
• Anti-Racism Policy

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Additional information:

Note:

• This ad is also available in French.
• About security checks:
  A criminal or other federal offence record does not automatically disqualify you from the position. We consider each situation based on the position's responsibilities.
  If a check is needed and you've lived outside of Canada in the past 5 years for 6 or more months in a row, or if you are not a Canadian resident, you'll need to provide an out-of-country police clearance certificate from the country you lived in.
  Employment screening checks are only reviewed and evaluated by the Transition and Security Office, which also maintains them and keeps them strictly confidential.
• N-HL-242234/26

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How to apply:

1. You must apply online.
2. Your cover letter and resume combined should not exceed five (5) pages. For tips and tools on how to write a concise cover letter and resume, review the Writing a Cover Letter and Resume: Tips, Tools and Resources.
3. Customize your cover letter and resume to the qualifications listed on the job ad. Using concrete examples, you must show how you demonstrated the requirements for this job. We rely on the information you provide to us.
4. Read the job description to make sure you understand this job.
5. OPS employees are required to quote their WIN EMPLOYEE ID number when applying.
6. If you require a disability related accommodation in order to participate in the recruitment process, please Contact Us to provide your contact information. Recruitment services team will contact you within 48 hours.

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.