Claims Administrator - Calgary, Canada - MSH International (Canada) Ltd.
Description
Job Overview
Process health or dental claims including verification of all aspects of claims eligibility required to provide accurate claims payment to, or on behalf of, insured members.
Other duties include handling inquiries related to claims payments, research and support related to provider or insured questions or concerns.
Responsibilities
- Medical or dental claims processing on v9 or VOC (verification of coverage) via portal
- Verifies eligibility of the insured and dependants;
- Checks premium status as required;
- Reviews banking information and currency desired as appropriate;
- Special attention given to claims over $5,000 in contract currency and potential or identified major cases;
- Assesses eligibility of services claimed according to policy provisions;
- Accurately assigns appropriate medical code or descriptor corresponding to service received;
- Updates data base with accurate information to issue a correct payment notice (insured claims) or to confirm accurate amount of payment via portal (direct billing claims);
- Forwards payment notices to Team Lead or Manager for validation (insured claims) or forwards results of VOC determination to appropriate repricing partners.
- Follows guidelines for Claims Adjudication as set out in Coding Manual;
- Supports the Customer Care team when research is required to answer or followup on concerns identified by insured members;
- Coordinates activities with different contact persons (sales, technical accounting, enrolment departments, implementation, IT, etc.) as required;
- Utilizes the following Intraqual tools as needed: the "Followup of Payments" Tool, the Medical Tool, the Case Management Tool, the "Request for Negative Claims" Tool;
- Handles additional administrative tasks as assigned.
Qualifications and Education Requirements
- College/University diploma/degree or equivalent work experience
- Ability to communicate (oral and written) in English. French/Spanish would be considered an asset.
- 13 years relevant business experience;
- Previous experience in the insurance industry/medical field;
Preferred Skills
- Detail oriented and committed to a high degree of accuracy;
- Strong analytical and organizational skills with strengths in prioritization and efficiencies;
- Ability to read and interpret a health insurance contract;
- Able to manipulate data correctly in multiple programs and spreadsheets;
- Strong focus on customer service and meeting the demands of internal and external clients;
- Able to work in a team environment;
- Able to work independently;
- Ability to multitask and adapt to various situations;
- Excellent communication (oral and written), grammar and business letter writing skills in English;
- Proactive attitude.
Job Types:
Full-time, Permanent
Benefits:
- Company pension
- Dental care
- Disability insurance
- Employee assistance program
- Extended health care
- Life insurance
- Paid time off
- RRSP match
- Tuition reimbursement
- Vision care
- Wellness program
Flexible Language Requirement:
- French not required
Schedule:
- 8 hour shift
- Day shift
- Holidays
- Monday to Friday
- Overtime
- Weekend availability
Supplemental pay types:
- Overtime
Ability to commute/relocate:
- Calgary, AB: reliably commute or plan to relocate before starting work (required)
Experience:
- Claims: 2 years (preferred)
Language:
- French (preferred)
- Spanish (preferred)
Work Location:
Hybrid remote in Calgary, AB
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