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Quality Assurance
3 weeks ago
People Corporation Winnipeg, CanadaJob Description · We are seeking a Quality Assurance & Senior Claims Assessor to join our Coughlin team in Winnipeg, MB. · The Quality Assurance & Senior Claims Assessor is responsible for conducting audits of claims in order to ensure that claims are processed accurately and i ...
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Quality Assurance
3 weeks ago
People Corporation Winnipeg, MB, CanadaWe are seeking a Quality Assurance & Senior Claims Assessor to join our Coughlin team in Winnipeg, MB. · The Quality Assurance & Senior Claims Assessor is responsible for conducting audits of claims in order to ensure that claims are processed accurately and in compliance with ...
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Payment Assessor
2 weeks ago
Manitoba Government Winnipeg, Canada**Payment Assessor**: · PA Payment Assessor · Regular/full-time · Workers Compensation Board · Compensation Services · Winnipeg MB · Advertisement Number: 2309 · Salary(s): PA $51, $64,950.00 per year · Closing Date: January 26, 2023 · The Manitoba government recognizes the impor ...
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Adjudicator
1 week ago
WCB Manitoba Winnipeg, Canada**Job Summary**: · The Adjudicator is responsible for adjudicating and managing Time Loss claims up to 8 weeks duration; Medical Treatment claims up to 14 weeks; Occupational Disease claims up to 8 weeks and Hearing Loss claims for the duration of the claim. As well, they are res ...
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Adjudicator
6 days ago
Workers Compensation Board of Manitoba Winnipeg, CanadaThe Adjudicator is responsible for adjudicating and managing Time Loss claims up to 8 weeks duration; Medical Treatment claims up to 14 weeks; Occupational Disease claims up to 8 weeks and Hearing Loss claims for the duration of the claim. As well, they are responsible for adjudi ...
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Payment Assessor
2 weeks ago
Workers Compensation Board of Manitoba Winnipeg, Canada1 Term Position · The Payment Assessor is responsible for gathering information and establishing all wage loss benefit rates for WCB claims according to existing policies, procedures and the Workers Compensation Act. · **Job Duties**: · Gathers, assembles, reviews, develops and a ...
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External - Payment Assessor - Summer Relief
2 weeks ago
Workers Compensation Board of Manitoba Winnipeg, CanadaMay 1, September 1, 2023 · 2 Summer Term Positions · The Payment Assessor is responsible for gathering information and establishing all wage loss benefit rates for WCB claims according to existing policies, procedures and the Workers Compensation Act. · **Job Duties**: · Gathers, ...
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Payment Assessor
3 weeks ago
Workers Compensation Board of Manitoba Winnipeg, CanadaUp to 2 One-Year Term Positions + Eligibility List · The Payment Assessor is responsible for gathering information and establishing all wage loss benefit rates for WCB claims according to existing policies, procedures and the Workers Compensation Act. · **Job Duties**: · Gathers, ...
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Case Manager
6 days ago
WCB Manitoba Winnipeg, Canada**Job Summary**: · The Case Manager is the primary contact responsible for the provision of case management services to an assigned region, industry and/or group of employers, and their injured workers. The incumbent is responsible for entitlement decisions and ongoing management ...
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Payment Assessor
2 weeks ago
WCB Manitoba Winnipeg, Canada**Job Summary**: · 1 Term Position · The Payment Assessor is responsible for gathering information and establishing all wage loss benefit rates for WCB claims according to existing policies, procedures and the Workers Compensation Act. · **Job Duties**: · Gathers, assembles, revi ...
Claims Assessor - Winnipeg, MB, Canada - People Corporation
Description
We are seeking a Quality Assurance & Senior Claims Assessor to join our Coughlin team in Winnipeg, MB.The Quality Assurance & Senior Claims Assessor is responsible for conducting audits of claims in order to ensure that claims are processed accurately and in compliance with established policies and procedures.
The Quality Assurance & Senior Claims Assessor is also responsible for identifying and recuperating overpayments and processing underpayments using defined procedures to research and resolve discrepancies.
Additionally, the Quality Assurance & Senior Claims Assessor will be responsible for investigating and determining the validity and eligibility of claims.
The Quality Assurance & Senior Claims Assessor provides or creates any requested reports, processes claims, performs other related administrative duties, and serves as a back-up to other senior positions in the Claims Department.
The Quality Assurance & Senior Claims Assessor will:
Technical Activities & Communication
Audit claims.
Process paperless and traditional claims, using the claims system to properly identify missing information on forms, and making adjustments to claims to correct errors.
Verify eligibility of members, drugs, services, providers, co-insurance, deductibles, payments, and procedure/dental codes, including reviewing previous submissions and group contracts/policies.
Produce claims payment cheques, including applying applicable deductibles.Investigate complaints, over and underpayments, and taking corrective action.
Interpret policies and administrative practices and correctly apply them in the adjudication of claims.
Provide accurate and timely information/assistance to members and clients concerning coverage, processing and paying claims, and benefits parameters.
Liaise with medical and dental professionals, plan administrators, and consultants.
Review and audit the work of Claims Assessors, ensuring accurate completion of tasks required by an internal audit.
Train new staff to use the claims system, to understand the policies and procedures of the department, and to provide excellent customer service.
Mentor and support staff, while resolving discrepancies and recommending measures to improve productivity and quality.T o be successful as a Quality Assurance & Senior Claims Assessor with Coughlin & Associates, you will need :
Completion of post-secondary education in a related field.
Minimum 3+ years of work related experience in health and dental claims adjudication or benefits administration.
Sound knowledge of medical and dental terminology in the concept of group or individual benefits administration.
Strong leadership abilities, including coordinating workflow, training subordinates, motivating a team and individual performance, and assisting in performance evaluations.
Strong working proficiency with the Microsoft Office Suite and standard office administration procedures.The demonstrated ability to learn and master new software and technology.
Training in industry related courses provided by CEBS (Certified Employee Benefits Specialists), LOMA (Life Office Management Association), the ICA (International Claims Association), or relation to Forensic Accounting or Fraud Investigation.
Bilingualism in both official languages.Experience processing electronic claims.
Extended health care and dental benefits
A retirement savings plan with company contributions
At People Corporation we are committed to helping businesses succeed. We are a national provider of benefits, retirement, wealth, wellness, and human resource solutions. Across the country, thousands of Canadians rely on Coughlin & Associates Ltd. to design and administer their group medical, dental, disability, life insurance and pension benefits. Claims adjudication and payment
We are dedicated to building a workforce that reflects the diversity of the communities in which we live, and to creating an environment where every employeehas the opportunity toreach their potential.
