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Express Scripts Canada administers claim adjudication services on behalf of Indigenous Services Canada . This role entails adjudicating Non-Insured Health Benefit Claims for Indigenous peoples in Canada.
The role of a Senior Claims Processor is to process health benefit claims. This includes registering, reviewing, validating, and adjudicating claims on a daily basis. Managing complex claims, which includes but is not limited to, client reimbursement claims. The Senior Claims Processor will work closely with internal and external partners to resolve claims processing issues and to identify claims processing improvements.
NOTE: We are open for Mississauga and Toronto both Office locations.
Key Responsibilities:
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Registers, reviews, validates, adjudicates and returns claims on a daily basis as per processes documented in the APM within our established Service Delivery Standards.
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Actively participate in ensuring the APM is updated within the required timelines
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Provide recommendations for improvement of processes with end-to-end considerations, i.e., suggested change in process, impact to all stakeholders, update of process documents, and support with training of claims processors
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Process complex claims which require an elevated level of critical thinking and skills.
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Act as the liaison person between claims and Indigenous Services Canada to address escalated inquiries within determined Service Delivery Standards.
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Handle and Support claims processing team as well as internal teams with inquiries and escalations.
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Complete Provider/Client call backs, when required.
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Participate in key projects that impact claims processing to meet internal and external needs.
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Identify efficiencies to streamline claims processing procedures.
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Support the training and development of the claims processing team.
Qualifications
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Strong communication, organizational and interpersonal skills
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Strong critical thinking skills to interpret data and generate insights independently
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Experience with data entry, with a focus on accuracy and precision
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Experience working in an operational setting an asset
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Experience in the group health insurance industry an asset Strong focus on customer service is required
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Ability to work effectively in a fast paced, rapidly changing environment
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Work well within a team
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Working knowledge of Microsoft Office Suite of Tools (Word, Excel, Outlook)
Note: Internal posting will close on November 6, 2023.
Express Scripts Canada is a Cigna company
Express Scripts Canada is a subsidiary of Express Scripts, a Cigna company. Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, wellbeing and peace of mind of those we serve. Cigna offers an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioural health, pharmacy, vision, supplemental benefits, and other related products.
About Express Scripts Canada
Express Scripts Canada is a leading health benefits manager and has been recognized as one of the most innovative. Our clients include Canada’s leading insurers, third party administrators and governments. We work with these clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment. We provide Active Pharmacy™ services to more than 7 million Canadian patients and adjudicate more than 100 million pharmacy, dental, and extended health claims annually. Through our proprietary consumer intelligence, clinical expertise, and patients-first approach, we promote better health decisions for plan members, while managing and reducing drug benefit costs for plan sponsors.
It will be a condition of employment that the successful candidate obtains an Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation to receive clearance if required.
We offer a competitive salary and benefits package, along with a positive work environment built on solid corporate values, integrity, mutual respect, collaboration, passion, service and alignment.
We are an equal opportunity employer that promotes a diverse, inclusive and accessible workplace. By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be.
We are committed to creating a working environment that is barrier-free and we are prepared to provide accommodation for people with disabilities.
If you require accommodation in completing the online application process, please email: eschr2@express-scripts.com Do not email eschr2@express-scripts.com for an update on your application or to provide your resume as you will not receive a response.
