Health Programs and Delivery Division - Claims Services Branch Position(s) language: 1 Permanent 09OAD - Office Administration 09 $28.14 - $32.82 Per hour* *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! Use your research skills to assess claims and analyze payment irregularities within strict deadlines.

Provide service to medical providers and the public. Deal with confidential and sensitive medical and personal information. 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. Ability to evaluate and adjudicate stakeholder claims. Proven ability to apply discretion and judgement to confirm eligibility for programs, determine when to elevate contentious issues/claims and adjudicate payment as applicable.

Ability to organize and manage own workload, process a high volume of claims and inquiries within strict timeframes. 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. How we support diversity, inclusion and accessibility We are building an inclusive workforce that reflects the communities we serve.

We encourage everyone interested in working with us to apply, including people with disabilities, Indigenous, Black and racialized individuals, as well as people from all ethnicities, cultures, sexual orientations, gender identities and gender expressions. Our hiring process is accessible, consistent with Ontario's Human Rights Code and the Accessibility for Ontarians with Disabilities Act, 2005. We are working to prevent and remove barriers in our hiring processes and can offer accommodation to address specific needs related to Code-protected grounds such as disability, family status and religion. diversity,



equity and inclusion initiatives Anti-Racism Policy The Ontario Public Service is one of Ontario's largest employers. adaptable learning and developmental opportunities, including education and mentorship programs many employee networks offering support for and education about underrepresented groups a defined-benefit lifetime pension plan (guaranteed, ongoing inflation-protected income after retirement) group health, dental, life and disability benefits a range of vacation and leave options an Employee and Family Assistance Program, which provides confidential counseling services 1 English Permanent - Full Time, 119 King St W, Hamilton, West Region, Criminal Record Check ~ A criminal or other federal offence record does not automatically disqualify you from the position.

If a check is needed and you've lived outside of Canada in the past 5 years for 6 or more months in a row, or if you are not a Canadian resident, you'll need to provide an out-of-country police clearance certificate from the country you lived in. Employment screening checks are only reviewed and evaluated by the Transition and Security Office, which also maintains them and keeps them strictly confidential.

Language requirements and assessment: All external Ontario Public Service (OPS) job ads are posted in English and French. Check the "position(s) language" section at the top of each job ad for the language requirements. For all roles, candidates are assessed in English, the business language of the OPS. If the position is bilingual (English/French), you'll also need to pass a French-language proficiency test. #

📌 Remote Claims Examiner (Contract (Canada)
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