Claims Specialist

This position focuses on completing work in the following core areas :

• Coordination and completion of pre-payment quality assurance and post payment verification processes for claim, and adjustments to ensure accuracy of submitted claims and issued payments;
• Investigation and resolution of complex customer service inquiries and technical issues related to claim, claim payments, claim advance and child registration;
• Recommending enhancements to the information system and coordinating testing plan and activities for the system;
• Coordinating, monitoring and reporting on the recovery activities;
• providing input on and drafting policy and training products aimed at both internal and external audiences, and
• Supervision of claim payment coordinators.

RESPONSIBILITIES AND ACTIVITIES

As one of the client Claims Unit key contacts and representatives, the Claims Specialist is guided by program and financial policies. The claims specialist applies a comprehensive body of knowledge of claims and associated child care program areas, their training and experiences to contribute to the effective and efficient administration of child care claim system. This will include providing advice, clarification and interpretation relating to operations, technology and program policy.

More specifically, the Claims Specialist will be responsible for managing (by email, telephone and correspondence such as Action Requests) customer service issues such as :

The position applies sound investigative and analytical skills when facilitating the resolution of these issues. The claims Specialist must have a full understanding of the impact of its role and decision-making on the work of others, both internally and externally.

2. Ensures Payment Accuracy

3. Coordinate and Monitor Grant Funding Recoveries

Claims Specialist is responsible for maintaining the process of collecting timely repayments from childcare providers whom the department has identified as owing funds back to the Ministry. This includes activities such as :

4. Supports Information System Functionality

Position assists in identifying opportunities for re-engineering, streamlining or enhancement of business processes.

Claims Specialist will be responsible for the development of testing scripts and coordination of testing resources for any enhancements done to the information system.

5. Supervision

The Claims Specialist may be assigned the supervisory duties as determined necessary by the Program Consultant - Claims or Manager Provincial Program. The duties may include onboarding and training of the new claim payments coordinator staff, assigning tasks and managing workloads, monitoring performance and identifying gaps in knowledge and training required.

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