Medical Claims Clerk

Job Description

We are seeking a Medical Claims Clerk to join our Coughlin team in Ottawa.

The Claims Clerk is required to process group plan member health claims by applying established policies and procedures, respond to written, electronic, or in-person inquires related to claims, benefits payable, and general group plan policies, and perform other related administrative duties.

The Medical Claims Clerk will :

• Responding to clients, members, or other external contacts in a prompt, efficient, and courteous manner at all times.
• Preparing correspondence using company standard templates for members, carriers, or clients.
• Providing accurate and timely information / assistance to members and clients concerning coverage, processing and paying claims, and benefits parameters.
• Informing the manager of any issues which arise out of the course of daily work.
• Liaising with medical professionals
• Data entry related to claims and member correspondence.
• Verifying eligibility of members, drugs, services, providers, co-insurance, deductibles, payments, and procedure / dental codes, including reviewing previous submissions and group contracts / policies.
• Verifying cheques, letters, forms, addresses, and reports for accuracy and completion.
• Producing claims payments, including applying applicable deductibles.
• Interpreting policies and administrative practices and correctly applying them in the adjudication of claims.
• Electronic data and document maintenance to include scanning, faxing, filing, destroying, photocopying, data entry and any processes required to prepare documents for these actions.
• Verifying work and data in the scope of the position for accuracy and completion.
• Prioritizing work to ensure effective time management.
• Maintaining procedure manuals, including documenting new procedures and updating current

procedures

To be successful as a Medical Claims Clerk with Coughlin & Associates, you will need :

• A good vocabulary of medical terminology.
• Sound knowledge in the concept of group or individual benefits administration.
• Sound knowledge of Microsoft Office and standard office administration procedures.
• The demonstrated ability to learn and master new software and technology.
• The ability to extract and interpret or simplify information from various technical sources.
• Strong mathematical and organizational skills, the ability to prioritize and multi-task, and the ability to manage time effectively.
• The ability to adhere to existing company policies and procedures.
• The ability to use tact and discretion to maintain information in the strictest of confidence

All-star candidates will have :

• Excellent grammatical, spelling, and communication skills in both official languages (English & French).
• The ability to maintain good public relations, both within and outside the organization.

What's in it for you :

• Learn by working alongside our experts
• Extended health care and dental benefits
• A retirement savings plan with company contributions
• A suite of Health & Wellness offerings
• Mental Health programs and support for you and your family
• Assistance for the completion of industry designations
• Competitive compensation

At People Corporation we are committed to helping businesses succeed. We are a national provider of benefits, retirement, wealth, wellness, and human resource solutions.

Our experts and solutions serve over 20,000 clients representing nearly 3 million Canadians. We offer customized solutions designed to fit the unique needs of businesses and their employees, members and stakeholders.

About Coughlin & Associates Ltd. :

Across the country, thousands of Canadians rely on Coughlin & Associates Ltd. to design and administer their group medical, dental, disability, life insurance and pension benefits.

Coughlin is a full-service benefits consultant and third party administrator. Our services include :

• Group benefits consulting and plan marketing
• Plan administration and correspondence
• Claims adjudication and payment

Established in 1958, Coughlin & Associates Ltd. provides services to some of Canada’s most respected companies, unions and public service organizations

Providing an inclusive, accessible environment, where all employees and clients feel valued, respected and supported is something we're committed to.

We are dedicated to building a workforce that reflects the diversity of the communities in which we live, and to creating an environment where every employee has the opportunity to reach their potential.