Drug technical claims consultant

The Group Benefits Technical Services, Health and Dental Claims Team

is looking for an analytical, self-starter to join their team as a Drug Technical Claims Consultant on a regular full-time basis. Reporting to the Manager, Health and Dental Claims Operations, the Drug Technical Claim Consultant is accountable for providing technical support to various internal and external customers on claims payment practices and procedures.

• Ensure that Drug Claims are handled in accordance with contractual policy provisions by establishing sound business rules/administrative guidelines for claims adjudication
• Provide technical expertise to internal and external customers to facilitate claims payment, resolve escalated complaints, manage new issue support etc.
• Provide technical expertise for the development of new product offerings, claim initiatives and client customizations that relate to the drug benefit
• Attend client meetings as required
• Attend litigation/arbitration sessions in court
• Accurate release of claims payments up to $80,000.00
• Ensure DIN files and drug plans are updated as new drugs, formulary and pricing information is introduced

• Post-Secondary education in a related field - pharmacy or nursing background would be an asset
• Thorough knowledge of the Claims admin/payment systems including GIPSY, GRID, Clients II, ESC and V3
• Computer proficiency with MS Word, Excel, Powerpoint

• Understanding of Federal and Provincial Health Care legislation would be an asset
• Excellent understanding of claim administrative procedures, contractual provisions and drug product offerings
• Excellent written/oral communication/customer service skills
• Good presentation and negotiation skills
• Strong analytical, research, problem-solving and decision-making skills
• Effective project management capabilities
• Ability to review and analyze critical data to make formal recommendations for process improvements
• General understanding of medical terminology, diseases and drug formularies
• Comfortable speaking with external parties such as pharmacists, health care providers, drug manufacturers, government agencies, plan members and plan sponsors etc.
• Must be able to decipher health industry information and understand how it relates to Group Benefits' plans
• Proven ability to manage/schedule a fluctuating, unpredictable workload
• General understanding of all Group Benefits departments

• We’ll empower you to learn and grow the career you want.
• We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words.
• As part of our global team, we’ll support you in shaping the future you want to see.

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