Claims Adjudicator - Edmonton, Canada - Government of Alberta

Government of Alberta

Verified Company

Edmonton, Canada

3 weeks ago

Posted by:

Sophia Lee

beBee Recruiter

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.

For more information on the work Alberta Health does, visit this link:

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.

With
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

A cover letter outlining how your experience relates to the qualifications of this role is required. Resumes submitted without a cover letter will not be considered.

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.

For more information on the Government of Alberta hiring process, view this link:
Links and information on what the GoA has to offer to prospective employees.