Claims Adjudicator - Open until filled.

Claims Adjudicator - Open until filled.

CL4 Clerk 4

Regular/full-time

Health, Seniors and Long Term Care

Insured Benefits Branch, Insurance Division

Winnipeg MB

Advertisement Number: 42198

Salary(s): CL4 $51,141.00 - $58,252.00 per year

Closing Date: March 31, 2024

The Manitoba government recognizes the importance of building an exemplary public service reflective of the citizens it serves, where diverse abilities, backgrounds, cultures, identities, languages and perspectives drives a high standard of service and innovation. The Manitoba government supports equitable employment practices and promotes representation of designated groups (women, Indigenous people, persons with disabilities, visible minorities).

Employment Equity is a factor in selection for this competition. Consideration will be given to Indigenous people and persons with disabilities.

An eligibility list may be created for future term and regular opportunities, subject to staffing approval, and may remain in effect until exhausted. This competition may also be used to source candidates for other clerk positions at the (CL4) classification.
To be considered for this competition, you must submit an application form and your resume. Complete the application form at the link below or contact Human Resource Services under “Apply to” to request a copy of the application form. The selection board will only rely on the information provided in this application form to determine whether a candidate will be invited for further assessment.

The Department of Health, Seniors and Long Term Care is currently seeking a Claims Adjudicator for the Claims Unit of the Insured Benefits Branch. This unit provides front-line service to fee-for-service providers through the adjudication of electronic claim submissions and responses to payment disputes/billing enquiries from practitioners. The position also provides front-line service to the public through the provision of information (email, telephone and written correspondence) regarding benefits under the provincial health plan.

Conditions of Employment:

• Must be legally entitled to work in Canada
• A satisfactory Criminal Record Check

Qualifications:
Essential:

• Experience with electronic processing and reconciliation of health claims.
• Experience with fee tariffs and Provincial Physician’s Manual.
• Experience interpreting and applying policies, procedures and/or regulations related to monetary pay outs and/or invoicing for services.
• Experience providing customer care, support and assistance in a professional environment.
• Strong verbal communication skills to effectively communicate with various stakeholders.
• Strong written communication skills.
• Excellent organizational skills to manage competing and rapidly changing priorities with strict timelines.
• Ability to maintain a high degree of accuracy in a fast-paced environment.
• Ability to make decisions and problem solve.
• Ability to take initiative and work independently with minimal direction/supervision.

• Knowledge of medical terminology.

Duties:
Using established rules and guidelines, Claims Adjudicators review and verify the accuracy of medical claims for insured services to ensure timely payment to medical practitioners. Claims are processed electronically using an electronic claims processing system, and may require additional analysis and manual calculations to ensure accuracy. Adjudicators will interact with service providers, medical practitioners and/or their billing agents via phone, e-mail and written correspondence to provide responses to inquiries about claims. Adjudicators will also respond to general inquiries about the claims submission process.

Apply to:

WHEN APPLYING TO THIS POSITION, PLEASE INDICATE THE ADVERTISEMENT NUMBER AND POSITION TITLE IN THE SUBJECT LINE AND/OR BODY OF YOUR EMAIL.

Applicants may request reasonable accommodation related to the materials or activities used throughout the selection process. When applying to this position, please indicate the advertisement number and position title in the subject line and/or body of your email. Your cover letter, resumé and/or application must clearly indicate how you meet the qualifications.

Please be advised that job competitions for represented positions may be grieved by internal represented applicants. Should a selection grievance be filed, information from the competition file will be provided to the grievor's representative. Personal information irrelevant to the grievance and other information protected under legislation will be redacted.

We thank all who apply and advise that only those selected for further consideration will be contacted.

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