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Claims Assessor--Talent Pool, Ministry of Health and Long-Term Care

Hamilton, Ontario
Deadline December 20, 2017

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 and Long-Term Care's health care delivery strategies? If so, bring your knowledge of medical terminology, and human anatomy and your ability to authenticate, adjudicate and facilitate payment of claims for health care benefits to our team!

What can I expect to do in this role?

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.

Location: Hamilton

How do I qualify?

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 and 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.

Salary Range: $23.46 - $27.35 per hour

Additional Information:

Permanent, 119 King St W, Hamilton, West Region, General Screening Requirement
Temporary, 119 King St W, Hamilton, West Region, General Screening Requirement

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 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.

Please apply online, only, by Tuesday, December 20, 2016, by visiting http://www.ontario.ca/careers and entering Job ID 100876 in the Job ID search field. Please follow the instructions to submit your application. Faxes are not being accepted at this time.

If you require accommodation in order to participate in the recruitment process, please contact us at http://www.gojobs.gov.on.ca/ContactUs.aspx to provide your contact information. Recruitment Services staff will contact you within 48 hours. Only those applicants selected for an interview will be contacted.
The Ontario Public Service is an inclusive employer. Accommodation will be provided in accordance with Ontario’s Human Rights Code.

http://www.ontario.ca/careers