Apply By: Monday, October 19, :59 pm EDT

Health Programs and Delivery Division - Claims Services Branch

City:

Hamilton

Position(s) language:

Job term:

1 Permanent

Job code:

09OAD - Office Administration 09

$28.14 - $32.82 Per hour*
*Indicates the salary listed as per the OPSEU Collective Agreement.

Come join our dynamic team of professionals in Hamilton
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

About the job

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.

What you bring to the team

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 elevate 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 recent 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.

Don't meet every qualification?

If you are excited about this position and meet most, but not all,



of the listed qualifications, please still consider applying. We recognize that no one person might have every qualification in this job ad, and you just might be the right candidate

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. For more information about accommodation during the hiring process please contact us.

Learn more about the work the OPS is doing to create an inclusive, anti-racist, accessible and diverse workplace:

- diversity, equity and inclusion initiatives
- accessibility
- Anti-Racism Policy

What we offer

The Ontario Public Service is one of Ontario's largest employers. Employees work for 29 ministries, with offices in more than 70 cities across the province. We offer:

- a career that can grow across ministries and job functions
- flexible learning and developmental opportunities, including education and mentor

📌 Claims Assessor (Canada)
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