Work Location : 9920 - 108 ST. Edmonton, Alberta
Client : Public Sector
Primary remote but may change to hybrid or onsite depending on the availability of workstations.
Description : Purpose
- Coordination and completion of pre-payment quality assurance and post-payment verification processes for claims, 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 Ministry's Childcare Claims Unit key contacts and representatives, 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 :
complex claims / adjustments questions and issues from childcare providers;problem‑solving childcare providers’ online submission errors for claims;resolving customer complaints and issues associated with claim, claim advance and adjustment payments.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.
Ensures Payment Accuracy
Monitors the system-generated quality assurance reports prior to the release of childcare claims for expenditure officer approval.Coordinates and monitors the post-payment verification process and reports on the progress and outcomes;Identifies any cases where errors or fraud may have occurred in the submission of a childcare claim.Reports on program internal controls, system gaps and risks.Prepares reports on claims activity using the Ministry's reporting and information systems. These may include : number of clients, client profile, etc.Identifies business information needs for inclusion into systems to support the administration and management of claims.Coordinate and Monitor Grant Funding Recoveries
Setting up tracking tools and maintaining up-to-date records on existing recovery cases.Drafting and issuing the repayment requests to childcare providers.Coordinating timely follow‑up activities for overdue repayments.Escalating complex repayment issues to the Supervisor.Reporting on the recovery progress, stats and outcomes.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 the coordination of testing resources for any enhancements done to the information system.Supervision
The Claims Specialist may be assigned the supervisory duties as determined necessary by the Program Consultant - Claims or the 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.
Professional Contacts, Relationships and Support
The Claims Specialist is responsible for developing and maintaining positive linkages with stakeholders and childcare providers, which will enable him / her to successfully carry out the outlined responsibilities, in addition to providing the Government of Alberta with a clear understanding of the extent and ramifications of policies. The incumbent will be called upon to provide information regarding Alberta's child care policy.
Activities
Work with other Ministry divisions / branches including Strategic Technology, Design and Innovation Branch, Program Evaluation, Information and Performance Management Branch, Child Care Delivery Branch, and Finance.Liaise with external stakeholders, including childcare providers and early childhood educators.#J-18808-Ljbffr