Claims Adjudicator

CL4 Claims Adjudicator

Regular/full-time

Department of Health and Seniors Care

Insured Benefits Branch, Insurance Division

Winnipeg MB

Advertisement Number: 38439

Salary(s):   CL4 $48,399.00 - $55,132.00 per year

Closing Date:   January 10, 2022

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. 

The Department of Health and Seniors Care is currently seeking to fill 4 Claims Adjudicator positions 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

• Must provide and maintain a satisfactory Criminal Record Check

Qualifications:

Essential:
 

• Experience with electronic processing of claims for services rendered, and/or claims invoicing systems.
• Experience interpreting and applying policies, procedures and/or regulations related to monetary pay outs and/or invoicing for services.
• Customer care experience providing courteous and respectful support/assistance to clients
• Strong verbal communication skills for effectively communicating with various levels of audiences.
• Excellent organizational skills for managing 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.
• Proficiency working with Microsoft Office applications (Word, Excel and Outlook).

Desired:
 

• Experience  processing and reconciling  claims in similar environment (insurance, health, dental, vision, drug).  
• Experience with fee tariffs and Provincial Physician’s Manual.
• Knowledge of medical terminology.

Duties:
Using established rules and guidelines, Claims Adjudicators are responsible for reviewing and verifying the accuracy of medical claims for insured services and ensuring timely payment to medical practitioners. Claims are processed electronically using an electronic claims processing system; however, complex claims may require analysis and manual calculations to ensure accurancy. 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 slubmission 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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