Claims Adjudicator - Edmonton, Canada - Government of Alberta
Description
Job Information
Job Requisition ID: 53487
Ministry:
Health
Location:
Edmonton
Full or Part-Time:
Full Time and Part-Time
Hours of Work: 36.25 hours per week
Permanent/Temporary: 3 vacant positions Permanent/Temporary
Scope:
Open Competition
Closing Date:
February 23, 2024
Classification:
Administrative Support 6
Salary:
$2,073.50 to $2,549.41 bi-weekly ($54,118 - $66,539 / year)
The Ministry of Health leads work in the areas of Alberta health insurance and benefits, doctors, hospitals and facilities, and other healthcare supports and information.
The Health Insurance Programs Branch (HIP) is responsible for administering the Alberta Health Care Insurance Plan (AHCIP) in compliance with Alberta and Canadian legislation and policy.
This includes the registration of eligible Albertans, Alberta practitioners and facilities; payment of claims to Alberta practitioners and residents; and special out of province/country programs for Albertans seeking access to medically required health services not available in Alberta and /or Canada.
Role Responsibilities:
The Claims Adjudicator acts as a direct resource of information to over 10,000 practitioners and all Alberta registrants for insurable or non-insured medical benefits and claims information.
This position will be cross-trained on all aspects of managing claims and will be heavily involved in: adjudicating medical and hospital claims, assessing highly complex surgical procedures that are received with supporting documentation, extensively researching and handling responses to various correspondence received from both service providers and the general public.
As the Adjudicator you will have sound medical terminology, knowledge of the Alberta Health Care Insurance Act, Regulations, Policy and Procedures including the Schedule of Medical Benefits (SOMB).
Your
drive for results will ensure that you accurately process claims by identifying and interpreting insured and non-insured benefits based on the SOMB.
creative problem solving, you will identify and investigate problematic claims to determine the appropriate resolution.
You have strong communication skills and the ability to
develop networks to effectively communicate with external stakeholders who may be affected by the assessment of claims, including Alberta residents, secondary insurance companies, other health plans, physicians, hospitals and other service providers.
With
systems thinking in mind, you will ensure that you are up to date with new legislation, polices and procedure relating to claim submissions and benefits to ensure accuracy and efficiency when processing claims.
If you have experience working in health care related field, with strong knowledge of medical terminology (including anatomy & various surgical and non-surgical medical techniques), are highly organized and thrives in a fast paced environment, then consider joining the Health Insurance Programs Branch.
APS Competencies:
Competencies are behaviours that are essential to reach our goals in serving Albertans.
We encourage you to have an in depth understanding of the competencies that are required for this opportunity and to be prepared to demonstrate them during the recruitment process.
This link will assist you with understanding competencies:
Qualifications:
High School Diploma plus a minimum of 4 years of progressively responsible experience is required. Knowledge of medical terminology and/or knowledge of anatomy and various medical techniques (surgical & non-surgical) is required
- Experience working with the Schedule of Medical Benefits
- Experience with processing claims and/or adjudicating claims
- Directly related clinical experience
- Experience delivering and/or assisting in the delivering of health services
Notes:
Hours of Work
hours per week (full time)
This position may be used to fill future vacancies across the Government of Alberta, at equal or lower classification and salary.
Other information:
- A cover letter outlining how your experience relates to the qualifications of this role is required
- Written assessment may be used as part of the screening/selection process.
Links and information on what the GoA has to offer to prospective employees.
- Working for the Alberta Public Service
- Pension plans: Public Service Pension Plan (PSPP)
- Alberta Public Service Benefit Information
- Professional learning and development
- Research Alberta Public Service Careers tool
- Positive workplace culture and worklife balance
- Leadership and mentorship programs
How To Apply
Applicants are advised to provide information that clearly and concise
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