Claims Assessor

Do you have an interest in providing timely, accurate and cost effective delivery of claim services to health care providers and the public? If so, bring your knowledge of medical terminology, human anatomy and your ability to authenticate, adjudicate and facilitate payment of claims for health care benefits to our team!

OPS Commitment to Diversity, Inclusion, Accessibility, and Anti-Racism:

We are committed to build a workforce that reflects the communities we serve and to promote a diverse, anti-racist, inclusive, accessible, merit-based, respectful and equitable workplace.
We invite all interested individuals to apply and encourage applications from people with disabilities, Indigenous, Black, and racialized individuals, as well as people from a diversity of ethnic and cultural origins, sexual orientations, gender identities and expressions.
Visit the OPS Anti-Racism Policy and the OPS Diversity and Inclusion Blueprint pages to learn more about the OPS commitment to advance racial equity, accessibility, diversity, and inclusion in the public service.
We offer employment accommodation across the recruitment process and all aspects of employment consistent with the requirements of Ontario's Human Rights Code. Refer to the "How to apply" section if you require a disability-related accommodation.

What can I expect to do in this role?

You will:
• Use your research skills to assess claims and analyze payment irregularities within strict deadlines.
• Respond to inquiries.
• Initiate payments, adjustments or recoveries.
• Provide service to medical providers and the public.
• Deal with confidential and sensitive medical and personal information.

How do I qualify?

Knowledge:

• Demonstrated knowledge of medical terminology and human anatomy to read and understand operative and emergency reports.
• Proven ability to understand, interpret and apply policies, work within guidelines, procedures and legislation to process claims and protect information and determine its disclosure.

Research/Analytical Skills:

• Ability to evaluate and adjudicate stakeholder claims.
• Ability to determine appropriate payment.
• Proven ability to apply discretion and judgement to confirm eligibility for programs, determine when to escalate contentious issues/claims and adjudicate payment as applicable.

Organizational Skills:

• Ability to organize and manage own workload, process a high volume of claims and inquiries within strict timeframes.

Tact, Diplomacy and Communication Skills:

• Demonstrated ability to provide detailed and understandable explanations (oral and written) on work processes and claims payments to internal and external clients.
• Demonstrated interpersonal skills to interact with clients and team members and to understand and respond appropriately to issues, dealing with conflict situations and/or with sensitive medical/financial information.
•Demonstrated experience working cooperatively in a team to meet deadlines and organization goals and assisting in the training of new and existing employees.

Mathematical and Computer Skills:

• Ability to calculate fees, recognize billing irregularities and reconcile payments and adjustments.
• Working knowledge of personal computers, mainframe applications, software (e-mail, word processing, internet, databases) and keyboarding skills to input/access/retrieve information and create correspondence and reports.