Claims Adjudicator

Role Responsibilities

The Claims Adjudicator acts as a direct resource of information to over 10,000 practitioners and all Alberta registrants for insurable or non-insured medical benefits and claims information. This position will be cross-trained on all aspects of managing claims and will be heavily involved in adjudicating medical and hospital claims, assessing highly complex surgical procedures that are received with supporting documentation, extensively researching and handling responses to various correspondence received from both service providers and the general public.

As the Adjudicator;

• You will have sound medical terminology, knowledge of the Alberta Health Care Insurance Act, Regulations, Policy and Procedures including the Schedule of Medical Benefits (SOMB). 
• Your drive for results will ensure that you accurately process claims by identifying and interpreting insured and non-insured benefits based on the SOMB. With creative problem solving, you will identify and investigate problematic claims to determine the appropriate resolution.  
• You have strong communication skills and the ability to develop networks to effectively communicate with external stakeholders who may be affected by the assessment of claims, including Alberta residents, secondary insurance companies, other health plans, physicians, hospitals and other service providers. 
• With systems thinking in mind, you will ensure that you are up to date with new legislation, polices and procedure relating to claim submissions and benefits to ensure accuracy and efficiency when processing claims. 

If you have experience working in health care related field, with strong knowledge of medical terminology (including anatomy & various surgical and non-surgical medical techniques), are highly organized and thrives in a fast paced environment, please apply today, we would like to meet you!

Please click on this link to view the job description for this position.

APS Competencies

Competencies are behaviors that are essential to reach our goals in serving Albertans. We encourage you to have an in depth understanding of the competencies that are required for this opportunity and to be prepared to demonstrate them during the recruitment process.

This link will assist you with understanding competencies: https://www.alberta.ca/system/files/custom_downloaded_images/psc-alberta-public-service-competency-model.pdf

• Agility - Proactively incorporates change into processes, Creates opportunities for improvement Is aware of and adapts to changing priorities. Remains objective under pressure and supports others to manage their emotions, Proactively explains impact of change on roles, and integrates change in existing work. Readily adapts plans and practices. 
• Drive for Results - Works to remove barriers to outcomes, sticking to principles, Forecasts and proactively addresses project challenges. Removes barriers to collaborate and achievement of outcomes. Upholds principles and confronts problems directly. Considers complex factors and aligns solutions with broader organization mission.
• Systems Thinking - Takes a long-term view towards organization's objectives and how to achieve them. Takes holistic long-term view of challenges and opportunities. Anticipates outcomes and potential impacts, seeks stakeholder perspectives. Works towards actions and plans aligned with APS values.
• Creative Problem Solving – Works in open teams to share ideas and process issues. Uses wide range of techniques to break down problems. Allows others to think creatively, voice ideas and brings the right people together to solve issues. 
• Build Collaborative Environment - Involves a wide group of stakeholders when working on outcomes. Involves stakeholders, shares resources and positively resolves conflict through coaching and facilitated discussion. Uses enthusiasm to motivate and guide others. Acknowledges and works with diverse perspectives for achieving outcomes. 

Qualifications

High School Diploma plus a minimum of 4 years of progressively responsible experience is required. Knowledge of medical terminology and/or knowledge of anatomy and various medical techniques (surgical & non-surgical) is required

Equivalency: Directly related experience or education considered on the basis of: one year of experience for one year of education or one year of education for one year of experience.

Refer to https://www.alberta.ca/alberta-public-service-minimum-recruitment-standards. 

Assets: experience working in the following areas are considered assets and should be indicated on your application. 

• Experience working with the Schedule of Medical Benefits
• Experience with processing claims and/or adjudicating claims

Preference will be given to candidates who have:

• Directly related clinical experience 
• Experience delivering and/or assisting in the delivering of health services

A cover letter outlining how your experience relates to the qualifications of this role is required. Resumes submitted without a cover letter will not be considered. 

Notes

This competition will be used to staff multiple positions.

Hours of Work:
36.25 hours weekly, Monday to Friday.

Location:
ATB Place North, 10025 Jasper Avenue, Edmonton, Alberta. This position requires working from the office with an option to qualify for a hybrid work arrangement (in accordance with GOA policy).

Other information: 

• This position maybe used to fill future vacancies across the Government of Alberta, at equal or lower classification and salary. 
• Top candidates may be required to undergo security screening

In your resume, please include dates (including months and years) associated with all education and work experience. Also, please indicate whether your work experience is casual, part time or full time.

Any costs associated with obtaining the required documents/checks as noted or interview travel expenses, will be the responsibility of the candidate. Out-of-province applicants can obtain the required documents/checks from the province they currently reside in. 

Links and information on what the GoA has to offer to prospective employees.

• Working for the Alberta Public Service – https://www.alberta.ca/advantages-working-for-alberta-public-service.aspx
• Pension plans: Public Service Pension Plan (PSPP) - https://www.pspp.ca
• Alberta Public Service Benefit Information - https://www.alberta.ca/alberta-public-service-benefits 
• Professional learning and development - https://www.alberta.ca/professional-development-support-directive
• Research Alberta Public Service Careers tool – https://researchapscareers.alberta.ca
• Positive workplace culture and work-life balance
• Opportunity to participate in flexible work arrangements such as working from home up to two days per week and modified work schedule agreement
• Leadership and mentorship programs