Claims Analyst

For over 75 years, Medavie Blue Cross has been a leading health and wellness partner for individuals, employers and governments across Canada. As a not-for-profit organization, we proudly invest in communities to help address some of Canada’s most pressing health care challenges. We are one of Canada's Most Admired Corporate Cultures, one of Canada’s Top 100 Employers, Canada’s Life & Health Insurer of the Year for 2021 and an Imagine Canada Caring Company. 
 
Our 2,400 professionals work across six provinces, united by our shared values of being caring, accountable, responsible, innovative and community-minded. We’re committed to ensuring our employees thrive in our award-winning, collaborative culture focused on ensuring health, wellness, and personal and professional growth through a variety of programs and support across our organization.
 
Together with Medavie Health Services, we are part of Medavie — a national health solutions partner with over 8,250 employees. Our mission is to improve the wellbeing of Canadians.

Position Summary

Reporting to the Team Leader, and working in a team environment, the Claims Analyst is responsible for a wide variety of complex medical claims from multiple programs with varying degrees of eligibility and policy requirements.  Using an online system, the Claims Analyst will assess, analyze, investigate and pay medical claims.  The Claims Analyst is required to maintain current knowledge with respect to policy and procedure changes.  The Claims Analyst will liaise closely with the MSI Medical Consultant, fellow staff, the Team Leader and the Manager on claims as they pertain to insured medical services.

Key Responsibilities

• Review, analysis, and appropriate payment of complex claims specifically; medical, optometry, nurse practitioner, out of province, out of country, special consideration, and exceptional circumstances in an accurate and efficient manner with high attention to detail on a daily basis
• Decipher detailed operative reports, record of operation and record of anesthesia, in order to provide appropriate payments of service.
• Liaise with Service Providers, their staff and Vendors in a professional manner with respect to system use, claims submissions, and payment reconciliations.    
• Provide excellent customer service when answering incoming phone calls and email enquiries.

Required Qualifications

• Education: Post secondary education in a health related field
• Work Experience: A minimum of 2 -3 years of related work experience.
• Other Qualifications: Able to adapt in a changing and fast paced environment with the ability to accept and implement changes; able to work independently. Knowledge of and or experience with physician billing in Nova Scotia considered an asset.
• Computer Skills: Strong computer skills and experience working with the Microsoft Office Suite especially Microsoft Excel; comfortable with information technology systems from a business user perspective.  Efficient keyboarding and word processing skills.
• Language Skills: Bilingualism would be considered an asset.

Core Competencies

• Knowledge: Demonstrates knowledge of customer needs and various processes and procedures in own work area as well as a general understanding of processes in related work areas.  Has a broad understanding of how Medavie Blue Cross works.
• Analytical Thinking: Uses business knowledge and experience to solve routine problems. Asks questions to determine the sources of the problem; discusses possible solutions and makes suggestions.
• Communication Skills: Communicates clearly and confidently verbally and in writing to a variety of audiences. Demonstrates the ability to tailor information and delivery to suit the nature of the material, audience and situation.
• Customer Orientation: Regularly handles routine customer questions and problems independently and proactively manages and monitors customer satisfaction while providing friendly and courteous customer service.
• Execution and Organizational Skills: Organizes work and information in a well thought out manner to deliver on specific tasks and milestones to meet deadlines. Exhibits high levels of energy and perseverance on the pursuit of established goals.
• Team Work: Demonstrates an understanding of how the job contributes to the overall work unit and helps others with problem situations without being asked.

We believe our employees should reflect the communities we serve and welcome applications from candidates of all backgrounds. To provide the best experience possible, we will support you with accommodations or adjustments at any stage of the recruitment process. Simply inform our Recruitment team of your needs.  We are committed to making sure recruitment, retention, advancement, and compensation are fair and accessible while following all relevant human rights and privacy laws. We appreciate everyone who has shown interest in this position. Only those selected for an interview will be contacted.