Maximus Looking for Medical Benefits Enquiries Customer Service Representative, Grid 14 at Victoria, BC Full Time

Company Profile:
Maximus Canada is an industry leader in the provisioning of products and services to support the delivery of government services in North America and internationally. With operations across Canada and around the globe, Maximus provides innovative, practical and meaningful solutions to help government programs and services function more effectively and efficiently.

We are constantly assessing new technology, processes and methods of delivering services to the citizens of Canada. With our expertise in program information management, claims processing, contact centre services, document processing and information technology, we are positioned for significant growth.

Maximus Canada offers competitive market-based salaries, comprehensive employer-paid benefits and a defined-benefit pension plan or a Group RSP with employer-matching contributions, for eligible employees. Our people also get some great perks too, such as employee appreciation events throughout the year, along with a supportive results-oriented work environment.

Maximus Canada welcomes and encourages applications from people with disabilities. Accommodations are available on request for candidates taking part in all aspects of the selection process.

Job Description:
Department Overview

On behalf of the B.C. government, Health Insurance BC (HIBC) administers medical coverage through the Medical Services Plan (MSP) and drug coverage through the PharmaCare and Fair PharmaCare programs. With a staff of ~180 unionized employees and 3 excluded managers, the HIBC Operations department delivers services measured by 20 SLRs and 29 SLOs via four teams:

Customer Service (PharmaCare Help Desk, Service Desk, Info Support, and Prosthetics and Orthotics)

Document Operations (Document Management, Document Processing, Admin Review, and Correspondence Liaison Unit)

Practitioner and Patient Services (Provider Programs, Benefit Services, Billing Support, and In Province and Out of Country Adjudication)

Operational Support Services (Medical Services and Pharmaceutical Services Support, Production Control, Support Coordinators)

Role Summary

This position reviews, researches and responds to enquiries within a call centre environment.

Calls can regard:
Medical benefits

Medical Histories

Practitioner registration and account maintenance

Claims submissions

Travel assistance

Payments for health care professionals, hospitals, clinics, laboratories, and the general public.

Alternative payment incentive programs

Teleplan Connectivity/support

In addition to call centre functions, this position is responsible for assessing and processing requests for the release of personal medical and Pharmacare information, court orders, beneficiary’s reimbursement requests for services, and for the registration and account maintenance of physicians and other medical providers eligible to participate in MSP.

This position additionally works with Providers and Data Centres that submit claims electronically via a computer system called Teleplan. The Clerk registers them in the system, then works with them (via a call centre) to ensure that they have connectivity, passwords and appropriate access.

This position also administers and maintains multiple special incentive programs for practitioners, including the calculation of payments based on program rules, payment processing, and payment tracking.

An extremely high level of privacy adherence, accuracy and professionalism is required in this role as it involves reviewing and discussing patient/practitioner histories and the maintenance of banking information.

Key Responsibilities

Answer and complete public and provider calls to meet our Average Speed of Answer and to provide excellent customer service.

Process documents provided by the public and providers, via HIBC forms and correspondence, to meet our SLR.

Process requests for reimbursements submitted by the public, via HIBC forms and correspondence, to meet our SLA.

Process requests for medical histories to meet our SLA.

Understand and comply to MAXIMUS, legislated and client policies and work procedures accurately, 98% of the time to meet our Quality SLR and to provide excellent customer service.

Manage your interactions with callers, clients and colleagues respectfully, collaboratively and professionally to contribute to a harmonious, productive work environment.

Education and Experience

high school diploma or GED equivalent, required, may be subject to standardized testing

proficient knowledge of MS Office, Outlook, ability to operate standard office equipment

2-3 years clerical experience in a documentation processing environment, preferred

experience explaining policies and programs to internal/external stakeholders, preferred

Understanding Principles of:
call control and customer situational judgment

customer service

plain language communication

professional, pro-social inter-relations

privacy and security of personal information

Knowledge, Skills and Abilities

Systems Use (B=basic A=advanced, E=expert)

MS Word: B Outlook: B CCA: A MaxImage: A R&PB: A PharmaNet: A CICS/CIPS: A MaxPath: A

Answer public and provider calls

articulate client policies clearly, neutrally, and quickly

assist callers in the use of on-line forms and in submitting applications/documentation/claims

control calls (paraphrase, actively listen, empathize, act)

update IT systems with validated provider information

troubleshoot provider connectivity problems, and determine solutions

electronically issue patient files and remittance statements

delete medical claims that are submitted in error

communicate key messages to providers via electronic fan out

utilize situational judgment skills

resolve escalations (transfers) from other departments

perform repetitive tasks and answer repetitive questions

use a computer for long periods of time

enter data at a speed of at least 40 wpm with a 98% accuracy

Process requests for reimbursements and documents provided from Providers and Public

validate information and documentation provided by the public and providers, reject or accept applications and requests, as appropriate

apply the HIBC policies that pertain to the form/correspondence you are processing, at the level of work you are assigned, then update our IT systems accordingly

release (or not) personal information to 3rd Party Requesters

correspond with public/providers to explain policy decisions and to seek or provide information

Process Payments

validate information and documentation provided by providers and health agencies, reject or accept applications and requests as appropriate

apply the HIBC policies that pertain to the payment you are processing, at the level of work you are assigned, then update our IT systems accordingly

release (or not) personal information to 3rd party requesters

correspond with agencies or providers to explain policy decisions and to seek information

reconcile financial information and report variances/anomalies

enforce audit recoveries

calculate incentive payments based on program rules

process inter-provincial reciprocal billing accounts payable and receivable

recover/negotiate overpayments and provider debit balances

process recoveries and maintain current account ledgers on behalf of the Receiver General and The Family maintenance Enforcement Program

Process requests for medical histories

validate information and documents provided by public

make decisions on and initiates reimbursements directly to beneficiaries

process requests for Court Orders forwarded from the Ministry of the Attorney General

interpret and use medical information in accordance with the Medical Services Commission Payment Schedule and Supplementary Benefits Schedules

verify that cheques have not been cashed, sends out affidavits for beneficiary to sign and return stating the money was not received

correspond with public/providers to explain adjudication decisions or request additional information

Understand and comply to policies/procedures set by MAXIMUS, legislation and our clients.

comply to all regulations, policies and procedures, with minimal intervention

learn new policies, procedures and computer applications within designated timelines

escalate work that is beyond the level you are assigned

obtain required approvals from designated personnel

document notes and actions, in our systems, that are clear, objective and useful to others

utilize designated channels and systems for making recommendations, communicating, reporting, etc.

report non-compliance of policies and procedures, regardless of the cause

Adhere to your work commitment and daily schedule.

manage personal time with minimal impact to work time

track and update weekly/monthly schedule expectations, as they are relayed

update your Scheduler/supervisor with changes to your schedule as soon as you are aware of them, and with consideration of our planning needs and the BCGEU Collective Agreement.

perform the work you are assigned within the designated time

report your time accurately, in the appropriate system, within deadlines

Manage your interactions with callers, clients and colleagues respectfully, collaboratively and professionally to contribute to a harmonious, productive work environment.

articulate concerns, ideas and opinions in a professional manner

de-escalate emotionally charged situations/calls

utilize pro-social skills (sharing, taking turns, manners, negotiation, problem solving, smiling, impulse control, interrupting/listening, dealing with mistakes, making decisions, etc.)

Core Competencies

Interpersonal Competencies

Relating Skills

approachability

interpersonal savvy

Managing Diverse Relationships

boss relationships

customer focus

managing diversity

peer relationships

understanding others

Dealing With Trouble

command skills

conflict management

Being Open and Receptive

composure

humour

listening

patience

Demonstrating Personal Flexibility

personal learning

self-development

self-knowledge

Business Competencies

Keeping On Point

timely decision making

priority setting

Getting Organized

organizing

planning

time management

Communicating Effectively

presentation skills

written communications

Additional Information:
In & Out of Service

We will be accepting applications until 11.59pm (PST) on March 18, 2022.

This position requires you to attend Maximus Canada’s facilities, client sites, and / or other in-person events. Accordingly, any successful applicant may be required to provide provincially recognized proof of having a complete series of COVID-19 vaccines as a pre-condition to accepting an offer of employment with Maximus. Should an applicant fail to provide sufficient proof of vaccination as required, their offer of employment will be rescinded.

New hires will start at a probationary rate of $26.72 up to 913 hours worked.

An eligibility list may be established for this role.

Please note this position is headquartered in Victoria British Columbia and is restricted to the geographic location within the 32-kilometer radius of the GVRD or CRD. This position is currently being performed remotely on an interim bases due to COVID-19. Please take this into consideration when accepting this position.