Claims Assessor

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Do you have an interest in providing timely, accurate and cost-effective delivery of claim services to healthcare providers and the public in support of the Ministry of Health's healthcare delivery strategies? 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!

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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.

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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.

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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.

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Additional information:

Note:

• The number of positions to be filled has not been identified at this time. This competition will be used to create an eligibility list of qualified candidates to fill upcoming opportunities within the next eighteen months following the closing date of the job ad posting.
• In accordance with the Ontario Public Service (OPS), Employment Screening Checks Policy (ESCP), the top candidate(s) may be required to undergo a security screening check. Refer to the above to determine the screening checks that are required for this position.
  
  Required security screening checks along with your written consent, will be sent to the Transition and Security Office (TSO), Corporate Talent Programs Branch, Talent and Leadership Division to evaluate the results. If applicable, the TSO, with your written consent, will request and obtain any additional employment screening checks that were not obtained directly by you.
  
  A record under the Criminal Code and/or other federal offence record(s) does not automatically mean you will be ineligible for the position. The employment screening check(s) will only be reviewed and evaluated by the TSO for the purpose of making a security clearance decision. The details of an individual's employment screening check(s) will be considered in specific relation to the duties and responsibilities of the position being filled. Employment screening check records will be maintained by the TSO and kept strictly confidential.
• T-HL-224295/24

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How to apply:

1. You must apply online.
2. Your cover letter and resume combined should not exceed five (5) pages. For tips and tools on how to write a concise cover letter and resume, review the Writing a Cover Letter and Resume: Tips, Tools and Resources.
3. Customize your cover letter and resume to the qualifications listed on the job ad. Using concrete examples, you must show how you demonstrated the requirements for this job. We rely on the information you provide to us.
4. Read the to make sure you understand this job.
5. OPS employees are required to quote their WIN EMPLOYEE ID number when applying.
6. If you require a disability related accommodation in order to participate in the recruitment process, please Contact Us to provide your contact information. Recruitment services team will contact you within 48 hours.

Please be advised that the results of this competition may be used to form an eligibility list of qualified candidates to potentially fill future vacancies represented by the Ontario Public Service Employees Union (OPSEU). In accordance with the Collective Agreement, eligibility lists are shared with OPSEU representatives. By applying to this competition, you are providing consent that your name may be shared with OPSEU representatives.

All external applicants (including former employees of the Ontario Public Service) applying to a competition in a ministry or Commission public body must disclose (either in the cover letter or resume) previous employment with the Ontario Public Service. Disclosure must include positions held, dates of employment and any active restrictions as applicable from being rehired by the Ontario Public Service. Active restrictions can include time and/or ministry-specific restrictions currently in force, and may preclude a former employee from being offered a position with the Ontario Public Service for a specific time period (e.g. one year), or from being offered a position with a specific ministry (either for a pre-determined time period or indefinitely). The circumstances around an employee's exit will be considered prior to an offer of employment.

All Ontario Public Service external job advertisements are posted in English and French. To confirm the language requirements of a job, check the "language of position" information at the top of each job ad. For all positions, candidates will be assessed in English, the business language of the Ontario Public Service. For English/French designated bilingual positions, candidates will also be assessed through French-language proficiency testing.

Toutes les offres d'emploi externes de la fonction publique de l'Ontario sont affichées en anglais et en français. Pour connaître les exigences linguistiques, vérifiez les renseignements sur la " langue du poste " figurant dans le haut de chaque offre d'emploi. Pour tous les postes, l'évaluation des candidates et candidats se fera en anglais, la langue usuelle de la fonction publique de l'Ontario. En ce qui concerne les postes désignés bilingues, la maîtrise du français des candidates et candidats sera également évaluée.

The Ontario Public Service is an inclusive employer.
Accommodation is available under the Ontario's Human Rights Code .