Claims processor Jobs in Old toronto, ON

Express Scripts Canada administers on behalf of Health Canada Dental Claim Adjudication. This role 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. Claims 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 role contributes to Express-Scripts Canada by meeting our Claims Processing Service Levels which contributes to customer satisfaction and minimizes risk of financial penalties.

This is a 3 month contract position

ESSENTIAL FUNCTIONS:

• Registers, reviews, validates, and adjudicates claims on a daily basis as per processes to meet minimum 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.
• Claim Adjustments that are given to processors by call centre/Supervisor/Senior Processors/QA Analyst due to errors are scanned and reviewed to ensure an error has been made, once a claim is adjusted, the information is fed back to call centre to be logged as complete.

QUALIFICATIONS:

• Experience with data entry, excellent accuracy
• Experience working in an operational setting an asset
• Experience in the group health insurance industry 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
• Ability to work within a team
• Working knowledge of Microsoft Office Suite of Tools (Word, Excel, Outlook)
• Ability to work or interpret data independently