Medical claims processor Jobs in 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 :

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 Pharmacy™ 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.