Claims Assessor/Client Liaison - Health Services

Details

Openings 1
Location Name
Alberta Blue Cross - Edmonton
Edmonton, Alberta, CA
Date Posted Sep 12, 2017
Profession Health
Career Level(s) Entry Level, Experienced (Non Manager)
Job Type(s) Permanent, Full Time
Education Level(s) Not Specified
Job ID job-9146

Position Summary

FUNCTION:

The overall responsibility in this position is to ensure that the claims we receive are appropriately managed. This involves accurate and efficient entry and adjudication of health claims. An additional critical component of this role is to handle phone inquiries from members, external service providers and internal customers, as well as initiating contact when needed to appropriately manage claims and advise on business processes.

DUTIES AND RESPONSIBILITIES:

  • Enter and manage health claims to ensure timely payment for our providers and members.
  • Research and compile information from various sources to resolve inquiries and claim discrepancies, consulting with senior staff if assistance is required.
  • Respond to telephone inquiries from members, external service providers and internal customers regarding all aspects of health benefits and claims assessment.
  • Follow through to ensure effective and efficient resolution of all telephone inquiries.
  • Contact providers and members to obtain necessary information to assess claims.
  • Adjudicate claims in accordance with unit procedures and Health Services standards with a high degree of accuracy and efficiency.
  • Monitor individual production to ensure that claim turnaround expectations are met.
  • Make suggestions to improve workflows and processes.

SKILLS AND KNOWLEDGE:

  • Demonstrated excellence in verbal communication and listening skills in the delivery of superior service to customers in previous roles.
  • Demonstrated excellence in accuracy and multi-tasking under tight time frames and heavy workload.
  • Demonstrated ability to work with minimal supervision and within a team environment.
  • Demonstrated problem-solving and decision-making capabilities as well as strong organizational skills.
  • Strong attention to detail and a desire for continuous learning.
  • Demonstrated ability to successfully support clients and key stakeholders over the phone.
  • Proficiency with Microsoft Office Suite is required.
  • Willingness to work scheduled shifts within business hours of 8:00 a.m. and 5:00 p.m.
  • Willingness to work extra hours and overtime hours as needed.

Alberta Blue Cross offers a competitive salary and benefits package and the opportunity to work in a challenging team-oriented environment.  This position will be open until suitable Candidates are selected.  If you have the qualifications we are looking for, please submit your resume and salary expectations to www.ab.bluecross.ca.


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