Claims Adjudicator

Introduction

The Department of Health, Seniors and Long-Term Care is currently seeking suitably qualified Claims Adjudicators for the Claims Unit of the Insured Benefits Branch. This unit provides front-line service to fee-for-service providers through the adjudication of electronic claim submissions and responses to payment disputes/billing inquiries from practitioners. The position also provides front-line service to the public through the provision of information (email, telephone and written correspondence) regarding benefits under the provincial health plan.

The Manitoba Government has a comprehensive benefit package which includes extended health care, health spending account, dental care, vision care, long term disability insurance, group life insurance, maternity/paternity leave, family related leave, and a defined pension plan (some pension plans allow for portability between the Civil Service Superannuation Board and employers).

To be considered for this competition you must submit an application form and a resume.

See below for further instructions.

Duties:
Using established rules and guidelines, Claims Adjudicators review and verify the accuracy of medical claims for insured services to ensure timely payment to medical practitioners. Claims are processed electronically using an electronic claims processing system and may require additional analysis and manual calculations to ensure accuracy. Adjudicators will interact with service providers, medical practitioners and/or their billing agents via phone, e-mail and written correspondence to provide responses to inquiries about claims.

Adjudicators will also respond to general inquiries about the claim’s submission process.

To be considered for this competition you must submit an application form and a resume. Complete the application form at the link below or contact Human Resource Services under “Apply to” to request a copy of the application form. The selection board will rely only on information provided in this form to determine whether a candidate will be invited for further assessment.

Note:

You are not required to submit a cover letter but may be asked to submit references, or other documentation at a later point if invited for further consideration.

Qualifications:

Essential:

Post secondary education in public administration, business, health, or administration. A combination of education, training and related experience may be considered.

Extensive work experience using and interpreting the Manitoba Physician’s Manual.

Experience interpreting and applying policies, procedures and/or regulations related to monetary payouts preferably in a healthcare setting.

Experience providing customer care, support and assistance in a professional environment.

Strong verbal communication skills to effectively communicate with various stakeholders.

Ability to make decisions and problem solve.

Ability to take initiative and work independently with minimal direction/supervision.

Experience using ICD-9 coding (The International Classification of Diseases, Ninth Revision).

Knowledge of medical terminology.

Conditions of Employment:

Must be legally entitled to work in Canada

Must provide and maintain a satisfactory Criminal Record Check.