- Registers, reviews, validates, and adjudicates claims on a daily basis as per processes to meet accuracy Service Level Standards.
- Monitors and handles pended claims to ensure they are settled according to the Service Level Standards.
- Return Claims that are missing mandatory client/benefit information as per using either claim entry or the doc reg screen and entering reason for the return. Address envelopes and attach provider return letter to claim and have clerical department send out all returns same day.
- Scans and reviews claim adjustments provided by the Call Centre/Supervisor/Senior Processors/QA Analyst to identify errors; After adjustments are made, ensures accurate information is relayed back to the Call Center for proper logging.
- Proficient with data entry with a proven track record of achieving high accuracy
- Experience working in an operational setting is considered an asset
- Experience in the group health insurance industry is considered an asset
- Strong focus on customer service is required
- Ability to work effectively in a fast paced, rapidly changing environment
- Excellent organizational and interpersonal skills
- Strong team player with demonstrated ability to collaborate effectively within a team environment
- Working knowledge of Microsoft Office Suite of Tools (Word, Excel, Outlook)
- Ability to work or interpret data independently with minimum supervision
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Claims Processor - Toronto, Canada - The Cigna Group
Description
Express Scripts Canada administers health benefits claims on behalf of Indigenous Services Canada. The role of Claims Processor entails adjudicating Non-Insured Health Benefit Dental Claims for Indigenous people in Canada.
The role of a Claims Processor is to register, review, validate, and adjudicate claims on a daily basis. Claim Processors are responsible for processing Pay Provider, Pay Client and Client Reimbursement claims for all regions and are responsible for ensuring all pended claims are processed within the standard turn-around time.
This position enhances department's performance by meeting service levels, thereby ensuring customer satisfaction and mitigating the risk of financial penalties.
Please note, this position requires to be on-site and can be based out of our Toronto and/or Mississauga offices.
ESSENTIAL FUNCTIONS:
QUALIFICATIONS:
Express Scripts Canada is a Cigna company
Express Scripts Canada is a subsidiary of Express Scripts, a Cigna company. Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, wellbeing and peace of mind of those we serve. Cigna offers an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioural health, pharmacy, vision, supplemental benefits, and other related products.
About Express Scripts Canada
Express Scripts Canada is a leading health benefits manager and has been recognized as one of the most innovative. Our clients include Canada's leading insurers, third party administrators and governments. We work with these clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment. We provide Active PharmacyTM services to more than 7 million Canadian patients and adjudicate more than 100 million pharmacy, dental, and extended health claims annually. Through our proprietary consumer intelligence, clinical expertise, and patients-first approach, we promote better health decisions for plan members, while managing and reducing drug benefit costs for plan sponsors.
It will be a condition of employment that the successful candidate obtains an Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation to receive clearance if required.
We offer a competitive salary and benefits package, along with a positive work environment built on solid corporate values, integrity, mutual respect, collaboration, passion, service and alignment.
We are an equal opportunity employer that promotes a diverse, inclusive and accessible workplace. By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be.
We are committed to creating a working environment that is barrier-free and we are prepared to provide accommodation for people with disabilities.
