Claims Processor -Express Scripts Canada

Description:

Express Scripts Canada administers on behalf of Indigenous Services Canada 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 ensuring data integrity in the system. 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 is instrumental in meeting our Claims Processing Service Levels which contributes to customer satisfaction and minimizes risk of financial penalties.

Please note, this is a hybrid role working 2-3 days out of our Toronto office after completing 4 weeks of on-site all 5 days training.

Key Responsibilities:

• Register, review, validate, and adjudicate claims on a daily basis as per processes documented in the APM in English

• Monitor and handle pended claims to ensure they are settled according to the Service Level Standards.

• Consistently meet the minimum accuracy standards of 98%.

• Consistently meet the productivity standards for assigned quotas within the established Service Delivery Standards.

• Participate in frequent quality and productivity touchpoints.

• Engage in bi-weekly claim department and monthly benefit process meetings.

• Handle claim adjustments that are provided from various departments.

• Participate in annual Privacy and Compliance Training.

Qualifications

• 1+ years’ experience with data entry with proven records of excellent accuracy

• Experience working in an operational setting an asset

• Experience in the group insurance industry an asset

• Proficient verbal and written communication skills in English

• Strong focus on customer service is required

• Quick learner and ability to make decisions with minimal supervision

• Strong analytical skills and ability to work or interpret data independently

• Self-motivation, determination and ability to work effectively in a fast paced, rapidly changing environment

• Excellent time management, organizational and interpersonal skills

• Working knowledge of Microsoft Office Suite of Tools (Word, Excel, Outlook)

NOTE: Internal candidates should apply before March 26, 2024.