Out of Province/Country Claims Coordinator (Clerk 3)

About Us

The Department of Health and Wellness offers opportunities to grow and advance in a dynamic sector that touches the lives of all Nova Scotians. Along with our partners, including the Nova Scotia Health Authority and the IWK Health Centre, we’re committed to continually improving our health care system. With a focus on collaborative primary health care, improved supports for mental health and addictions, digital health, capital infrastructure, and more, the department is thinking differently about how to plan, fund, legislate and monitor to improve access and service delivery. To do this, we need leaders at all levels of the organization who embrace a challenge and believe in their ability to make a difference.

About Our Opportunity

This role offers a meaningful opportunity to support Nova Scotians who require medically necessary care outside the province or country. As an Out of Province/Country Claims Coordinator, you play a key role in ensuring eligible residents receive accurate, timely, and fair consideration of claims for approved medical services obtained elsewhere.

Working within the Department of Health and Wellness and under the guidance of the Manager, Out of Province/Country Programs, you assess eligibility and adjudicate claims in accordance with legislation, policies, and program guidelines. This includes reviewing and interpreting clinical documentation, applying medical terminology and judgment to assess medical necessity, and evaluating records that may originate from international jurisdictions and require translation.

You are responsible for assessing appropriate payment amounts, resolving claims processing and billing issues, and ensuring adherence to established guidelines, timelines, and financial controls. Where claims are denied, you provide clear written explanations to applicants and other affected parties to support transparency and procedural fairness.

This position requires strong attention to detail, sound judgment, and discretion when working with sensitive personal health information. You will engage with a range of stakeholders, including patients, healthcare providers, and internal teams, in a collaborative, inclusive environment grounded in public service, accountability, and integrity.

Primary Accountabilities

The incumbent is responsible for adjudicating and coordinating medically necessary out of province and out of country claims, including emergency and pre approved services, in accordance with Department of Health and Wellness policy and the Canada Health Act. This includes independently assessing eligibility and entitlement, interpreting complex clinical documentation, applying medical terminology and diagnostic coding standards, and determining appropriate payments or denials.

The role involves reviewing and processing complex foreign medical billings, manually calculating payments including currency conversion and insurer discounts, ensuring accuracy of ICD 10/11 coding, and preparing clear, well documented approval and denial decisions. The incumbent coordinates benefits and payments with applicants, service providers, insurers, MSI, and other stakeholders, and maintains accurate records within the claims processing system.

The incumbent resolves complex claim issues, requests and validates supporting documentation from domestic and international stakeholders, and responds to sensitive inquiries from individuals experiencing medical, financial, and emotional stress. The role also includes identifying third party liability or overpayments, supporting recovery and financial controls, contributing to reporting and system accuracy, and participating in program improvement initiatives, including digital transformation and system testing.

Qualifications and Experience

To be successful in this role, you will bring a combination of relevant education, experience, and transferable skills.

You will have:

• High school graduation with four years of progressively responsible related experience; or an equivalent combination of training and experience. Relevant post secondary education or coursework in health administration, medical office administration, business, or a related field is considered an asset.
• Experience in claims processing, health administration, insurance, or a related administrative or adjudicative role involving the application of eligibility, coverage decisions, and entitlement criteria within complex policies, legislation or guidelines.
• Experience handling financial transactions, payment calculations, or reconciliations with a high degree of accuracy.
• Demonstrated ability to interpret medical terminology and clinical documentation, with experience applying eligibility or coverage criteria to support adjudication or benefit determination.
• Strong attention to detail and proven ability to perform complex calculations, manage detailed documentation, and complete data entry with a high degree of accuracy, including work with financial or payment-related information.
• Experience communicating clearly and professionally, both in writing and verbally, with individuals from diverse backgrounds, including sensitive, stressful or emotionally charged situations.
• The ability to manage multiple priorities, meet deadlines, and exercise sound judgment independently in the interpretation and application of policies and guidelines.
• Comfort working with computer systems and databases, and the ability to learn, navigate and accurately maintain information within specialized claims or case management systems.
  
  

We will assess the above qualifications and experience using tools such as assessments, presentations, interviews, reference checks, etc.

Equivalency

We recognize that experience can be gained in many ways. An equivalent combination of education, training, and experience may be considered.

Applicants relying on education and experience equivalencies must demonstrate such equivalencies in their application.

Benefits

Based on the employment status and union agreement, the Government of Nova Scotia offers its employees a wide range of benefits such as a Defined Benefit Pension Plan, Health, Dental, Life Insurance, General illness, Short and Long Term Disability, Vacation and Employee and Family Assistance Programs. For information on all our Benefit program offerings, click here: Benefits for government employees.

Working Conditions

Normal work week is 35 hours/week, 7 hours/day.

May be required to work overtime on occasion.

What We Offer

• Career development where you have access to career guidance, tools, resources, and ongoing training for every stage of your career
• Engaging workplace: our employees feel valued, respected, connected, and tuned in, we have forward-thinking policies and strategies
• Countless career paths
• A Dynamic, client-focused office environment where service excellence and teamwork are our focus.