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Title posted on Jobillico - Bilingual Claims Analyst - Remote
Posted on December 19, 2024 by Employer details Medavie
Job details
<p><b>Position Type:</b></p>Permanent<p></p><p></p><p>If you?re looking for a fulfilling career that can make a real difference in your life, and the lives of others, you?ve come to the right place.</p><p></p><p>As a national health solutions partner, we put people first in everything we do - and that begins with our team of 8,000+ professionals who bring a cross-section of diverse life experiences and career expertise to Medavie. By collaborating and innovating together, our employees are creating industry-leading solutions in insurance, primary care and emergency medical services that impact millions of lives in Canada each year.</p><p></p><p>Our mission is to improve the wellbeing of Canadians so that every life can be lived to the fullest - and it?s reflected in our award-winning culture. We celebrate individuality and value the diverse perspectives and skills our employees contribute. We go beyond providing competitive pay and comprehensive benefits to offer opportunities for personal and professional growth, flexible work options, meaningful experiences, and supportive leadership. Medavie is where employees can be their best selves, feel they belong, and achieve their full potential. Be part of it by applying for a position with us today.</p><p></p><p></p><p><b>Job Title: </b>Bilingual Claims Analyst</p><p><b>Department: </b>Member Experience</p><p><b>Competition:</b> R-242975 </p><p><b>Internal/External: </b>Internal/External </p><p><b>Employment Type: </b>Full Time Permanent</p><p><b>Location: </b>Remote Québec</p><p><b>Salary: </b>20,61$ per hour/ comprehensive benefits/ bonus</p><p><b>Reports To: </b>Team Leader</p><p></p><p></p><p></p><p><b>Position Summary: </b></p><p></p><p>Under the Team Leader?s supervision, you are responsible for processing standard or complex claims relative to your decisional level in accordance with the policies and procedures for claims payment. </p><p>You respond in writing to and follow up on internal requests for adjustments related to previously processed/submitted transactions or any requests requiring payment of a claim, using good judgment and your knowledge of the company?s products and/or services.</p><p>To help you perform your duties, you use a computer system to obtain and/or transmit information.</p><p></p><p></p><p><b>Key Responsibilities:</b></p><p></p><p>? Analyze health/dental insurance claims (Regional and National Groups) for both special groups and requests for adjustments to determine if the expenses submitted are eligible for the insurance benefits and, if necessary, deny claims;<br>? Obtain all required information prior to payment of claims from special groups/requests. Research and communicate in writing or by phone with the client, as needed, to process the claim fully when received;<br>? Enter the data in the computerized claims processing system; </p><p>? Conduct necessary research to accurately respond to queries using various systems, tools, and resources available;<br>? Use the computer system when responding to various requests in order to accept or deny claims in accordance with the contract and/or eligibility of the insured and by applying company policies and procedures; <br>? Demonstrate excellent analytical and judgment skills in connection with the contractual requirements of certain groups, which involves researching websites, including government websites;<br>? Process health/dental claims for new groups being monitored for a predetermined period in order to analyze all denials and ensure they are in compliance with the contracts. The analysis must be carried out using the contracts and/or Master App as well as all available tools. Denials that are not in compliance with the contract are submitted for validation;<br>? Perform all calculations required to pay a claim when the computer system cannot calculate them automatically;<br>? Support continuous improvement by seeking and identifying opportunities for improvement to processes and tools from- LocationMontréal, QC
- Workplace information On site
- SalaryNot available
- Starts as soon as possible
- vacancies 1 vacancy
- Source Jobillico #15012611
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