Job Description
Are you an expert in medical claims adjudication with a keen eye for policy interpretation? Do you have strong analytical skills and exceptional verbal and written communication? If so, we would love to meet you!
As a Coverage Assessor, you will play a key role in reviewing medical claims, assessing eligibility, and ensuring policy compliance with precision and efficiency. You will evaluate eligibility of inpatient claims for coverage and apply policy benefits and limitations, based on a comprehensive claim review and assessment. The Coverage Assessor has ownership of the claim journey after the active emergency has ended and will determine and oversee the collection of required documentation to support their analysis and application of benefits, limitations, and exclusions.
What does your typical day look like?
Analyze all information pertaining to the claim including medical records, medical declarations, policy wording, and file specific communications;
Ensure policy wording, medical declaration, and intent are applied precisely;
Proactively obtain and compile necessary information to achieve efficient turnaround time;
Monitor missing information for escalated claims and intervene, when necessary, and involve leadership where applicable;
Prepare clear case summaries for corporate client submission where GEM’s authority thresholds are exceeded;
Handle appeals, participate in internal & client rounds, and provide guidance in active case management;
Communicate claim progress and coverage issues to claimants, request missing claim components for adjudication, and compose denial letters and handle communication regarding claim denials;
Review bills for services, coding, and reasonable charges, direct bills to internal financial processes, and confirm claim requirements;
Identify continuous improvement initiatives and be able to adapt to new processes and policies as needed;
Additional responsibilities may be required based on business, department, and team needs.
What skills and training do you need?
Post-secondary education or equivalent;
Minimum one year of claims adjudication experience required;
Comprehension of healthcare systems and billing practices;
Sound knowledge of medical terms and information;
Sharp analytical mindset and excellent problem-solving skills;
Planning, time management, and organizational skills;
Excellent interpersonal skills, judgment, and professionalism;
Fluent in English (written and verbal) for corporate client and external partner communications;
Excellent communication skills (written and verbal) and other languages would be considered an asset;
Proficiency in Microsoft Office suite of products.
If you're ready to take the next step in your career, apply today and make an impact!
When you apply:
If you require assistance or accommodation during our recruitment process, please notify Human Resources so that we can review and consider how we may be able to assist you based on your individual needs.
We offer you
Global Excel offers more than a position;
We offer a competitive compensation package that includes a base salary, performance bonus and an extensive benefits package;
A professional future with opportunities for development, growth, and advancement;
RRSP Match program;
Financial assistance to employees who wish to continue their education;
Work/life balance, health and wellness initiatives including an excellent EAP program;
Employee engagement programs that focus on fitness, food, and fun.
To get a taste of the Global Excel life and for more information on our company, visit our Facebook page and website:
