Overview

Alberta Blue Cross Senior Claims Assessor, Spending Accounts- Health Services Full Time in Edmonton, AB

Alberta Blue Cross

Branch Edmonton AB CA

Position:
Senior Claims Assessor, Spending Accounts- Health Services
Location:
Edmonton, AB

As a back up to the team manager, provides a weekly production report and provides a work plan for the following week’s production….

FUNCTION:

With the support of the appropriate Team Manager in Health Services, the Senior Claims Assessor is responsible for ensuring claims are adjudicated efficiently and effectively. The successful candidates will work as the senior resource and support for in-house staff, including managing difficult claims. In addition, the successful candidates are responsible for providing regular feedback to the Team Manager regarding claim turnaround. The successful candidates will provide exceptional service to internal and external customers. They will have demonstrated leadership skills, exemplary interpersonal skills, and strong problem-solving abilities.

DUTIES AND RESPONSIBILITIES:

  • Expert resource for the department.
  • Ensures claims are processed and paid in accordance with contract provisions.
  • Identifies and reports to the team manager any adjudication or system problems.
  • As a back up to the team manager, keeps staff informed and up-to-date on changes in procedure and policy affecting their areas of responsibility and provides on the job training where required.
  • Analyzes more complex claims and advises staff or team manager accordingly.
  • Identifies necessary changes to improve overall operation of adjudication.
  • Initiates and responds to correspondence and telephone inquiries from providers of service, other insurance carriers and members when matters cannot be handled by the assessors.
  • Reports, in documented form to the team manager, any discrepancies or suspect claims that are not in line with contractual agreement.
  • As a back up to the team manager, provides a weekly production report and provides a work plan for the following week’s production.
  • As a back up to the team manager, assists as liaison between other departments within Alberta Blue Cross, or external partners as required.
  • Works with the team manager to develop and maintain co-operative working relationships within the unit. Shows awareness and consideration for the opinions and feelings of others.

SKILLS AND KNOWLEDGE:

  • Demonstrated leadership abilities.
  • Demonstrated excellence in oral communication and listening skills in the delivery of superior service to customers.
  • Demonstrated ability to work with minimal supervision and within a team environment.
  • Demonstrated problem-solving and decision-making capabilities.
  • Demonstrated excellent organizational skills.
  • Proficiency with Microsoft Office would be a definite asset.
  • Experience in leadership role would be an asset.
  • Familiarity with government and community health programs and services would be beneficial.

This position will remain open until a suitable candidate is selected. If you have the qualifications we are looking for, apply online at www.ab.bluecross.ca .

or proceed with Standard Application Form.

Employment Type: Full Time
Location: Edmonton, AB, CA
Posted on: 2016-05-20
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