Claims Jobs in St. Albert, AB

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.