The Bilingual Claims Analyst is responsible to competently and efficiently review hospital billing claims and audit questionnaires using a specific claims processing system developed by the client. Will be responsible to ensure contact is made for service providers, customers and plan administrators to resolve claims efficiently and accurately via verbal and written correspondence. Additional accountabilities include: maintaining departmental and client expectations as outlined in the service level agreement, adhere to all corporate/regional policies and procedures, maintain turnaround time and quality of processing and abide by assigned work schedule.
- Analyze historical data and assess relevant group policy and/or provincial guidelines to review and access hospital review and questionnaire claims related to Hospital benefit types.
- Deliver first class service by accurately assessing and responding to customer needs, using sound judgment when recommending appropriate solutions.
- To fulfill customer/provider requests, respond to inquiries/complaints, demonstrating due attention to customer/provider care and a professional approach at all times.
- Demonstrate good judgement and confidence with respect to adjudication decisions.
- Ensure daily production meets the set standards of 100%, above required data entry/adjudication targets as outlined.
- Ensure daily accuracy rates meet company standards as per the departmental contract.
- Work as a team player to ensure daily targets are achieved.
- Maintain accurate and complete record keeping and reporting as required.
- Adhere to all corporate and client confidentiality agreements and policies.
- Work in a co-operative, courteous and supportive manner at all times.
- Must have strong verbal communication skills in both official languages English and French required.
- Hours of Operations: Monday to Friday, 9:00am to 5:00pm however a flexible schedule (evenings, weekends or overtime up to 48 hours /wk) if required.
- Minimum data entry speed of 8,000 keystrokes per hour, minimum Accuracy Rate of 99%
- Strong and developed oral and written communication skills, including typing, spelling and grammar.
- Demonstrated passion for customer satisfaction excellence and prior experience.
- Ability to analyze data and make informed decisions.
- Ability to recognize errors and undertake corrective processes.
- Dependable and dedicated with strong work ethics.
- Detail-oriented, multi-tasker.
- Act as a SWAT team member by attending client conference calls as needed.
- Ability to support and relay relevant information to coworkers.
- Ability to perform under stressful conditions such as directional changes, tight deadlines, and limited resources.
- Work patiently and effectively with team deadlines, structures, and peers.
Special Requirements: Clear Credit and Criminal background check, and PERC clearance for the GOV sector, prior to commencing work.
Millennium1 Solutions is an equal opportunity employer and welcomes and encourages applications from people with disabilities. Accommodations are available on request for candidates taking part in all aspects of the selection process.