U968 - Claims Auditor I

U968 - Claims Auditor I

01 Jul
|
Telus Communications Company
|
Toronto

01 Jul

Telus Communications Company

Toronto

Temporary position (12 months)



Join our team



Here’s the impact that you’ll make and what we’ll accomplish together



Reporting to the Manager of Audit, the Claims Auditor is responsible for conducting claims audits on behalf of our customers to validate claims submitted by providers and ensure their compliance to the terms and conditions set out in the provider agreement. Auditor will typically specialize in one particular line of business (i.e. drug vs. dental).



Here’s how



- Conduct various types of audits including desk, cardholder, on-site, compounds and mailers, Open-windows

- Gather and compile data from multiple sources including providers, cardholders, physicians and dentists



- Complete investigation and report on findings

- Process adjustments and reversals on the transactions as required

- Maintain complete and accurate documentation of all audit related information, reports and conversations

- Manage multiple assignments at one time and provide back up support to other auditors

- Provide basic technical support to Insurance Companies, Providers, Help Desk and other teams in Client Services

- Contribute to achieving team objectives and delivery on service level commitments including all SLA’s





Required Knowledge, Skills & Abilities



- Knowledge of business flows in claims management and submission – working knowledge

- LOMA, CEBs, ICA, HIAA training would be an asset – working knowledge

- Knowledge of Microsoft Office and Network systems – intermediate

- Knowledge of pharmacy, dental, Extended Health and/or audit practices – working knowledge

- Ability to manage confidential information and protect privacy – intermediate

- Performs well under pressure and demonstrates effective time management skills; ability to effectively multitask – intermediate



Required Professional Accreditation or Certification



- High school completion

- College diploma in health sciences or administration is preferable

- Minimum requirement of high school diploma



Required Equivalent Experience



- 1-3 years Pharmacy experience

- Minimum of 1-3 years’ experience in a retail pharmacy, hospital pharmacy, dental or extended healthcare practice

- Claims Examiner experience an asset



A bit about us



Our business is connecting Canadians. Our social impact is using our world-leading technology to create meaningful change, give back to help communities thrive, and help those who need it most. When you join our team, you’re helping us make the future friendly. We’re committed to diversity and equitable access to employment opportunities based on ability —your unique contributions and talents will be valued and respected here.

TELUS Health is an IT leader in Canada that focuses on the health sector. Our mission is to improve the way information is being used along the continuum of care to better the health of citizens in Canada and in selected countries.



Disclaimer: In accordance with the TELUS Health Solutions Data Center Security Policy, as a condition of employment, all personnel whose job functions require they work at a Data Center and/or have access to detailed knowledge of technology related to client service delivery, are subject to a Personnel Security Screening conducted through the Government of Canada.

The original job offer can be found in Kit Job:
https://www.kitjob.ca/job/19918960/u968-claims-auditor-i-toronto/?utm_source=html

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