CLAIMS ASSESSOR

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Bring your knowledge of medical terminology and human anatomy, and your exceptional analytical skills to our team at the Ministry of Health and Long-Term Care to process medical claims.

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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

Mandatory:

•You are proficient in English and in oral French at the advanced level

Research and Analytical Skills:

• You have proven research and analytical skills to evaluate and adjudicate stakeholder claims to determine appropriate payment and confirm eligibility for programs
• You have proven ability to apply discretion and judgement to determine when to escalate contentious issues and claims and adjudicate payment as applicable

Communication and Interpersonal Skills:

• You demonstrate communication and interpersonal skills to provide detailed and understandable explanations on work processes and claims payments to internal and external clients and interact with team members
• You demonstrate tact and diplomacy to understand and respond appropriately to issues, dealing with conflict situations and/or with sensitive medical and financial information

Technical Knowledge and Skill:

• You have knowledge of medical terminology and human anatomy to read and understand operative and emergency reports
• You have proven ability to understand, interpret and apply policies, and work within guidelines, procedures, and legislation such as Freedom of Information and Protection of Privacy Act

Organizational and Team Work Skills:

• You have well developed organizational skills to organize and manage workload, process a high volume of claims and inquiries within strict timeframes
• You have proven ability to work cooperatively in a team to meet deadlines and organization goals, and assist in the training of new and existing employees

Other Essential Skills:

• You have Mathematical skills to calculate fees, recognize billing irregularities and reconcile payments and adjustments
• You have demonstrated experience using personal computers and software (e-mail, word processing, internet, databases) as well as keyboarding skills to input, access, retrieve information and create correspondence and reports

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Additional information:

Note:

• This ad is also available in French.
• Prior to the offer of employment, in accordance with the Ontario Public Service personnel screening checks policy, the top applicant(s) will be required to undergo personnel screening checks, which includes a police records check.
• T-HL-49014/12

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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.