Pacific Blue Cross Looking for Benefit Claims Examiner – EHC at Burnaby, BC Full Time

Pacific Blue Cross has been British Columbia’s leading benefits provider for 80 years. We are an independent, not-for-profit society with strong roots in BC’s health care system. Together with our subsidiary BC Life, we provide health, dental, life, disability and travel coverage to 1 in 3 British Columbians through employee group plans and individual plans.

We are fueled by a commitment to keep health care sustainable for all British Columbians. Through our Pacific Blue Cross Health Foundation, we also provide funding to community organizations with a focus on alleviating mental illness and chronic disease. We’re interested in finding people who want to make a difference and who will take advantage of every opportunity to build a career with us.

Pacific Blue Cross offers an attractive compensation and benefits package, fitness programs, and an onsite gym and cafeteria. Our workplace culture values health and wellness, continuing education, environmental sustainability and giving back to the community.

We are currently recruiting for 6 permanent full-time Benefit Claims Examiners to join our Extended Health Care claims team. This role will require working from both, our head office in Burnaby, and home (hybrid).

Duties and Responsibilities:
Claims Adjudication

Analyzes a wide range of benefits claims to identify action necessary to process claims reimbursements and adjustments, to initiate coordination of benefits or to reject claims by:

reviewing computer-generated reports, printouts, claims receipts, and related materials such as provider and medical reports, and accessing on line systems to identify provider and member claims information;

reviewing group contracts to identify provider benefits, fees and contract limitations;

assessing claims history and comparing to claims under review to determine eligibilities and entitlements, including out of province and out of country requests for reimbursement; approves payment within established limits;

identifying reasonable and customary fees associated with claims, assessing where fees fall outside of normal guidelines and approving for payment based on past practice or referring to other department claims specialists, Team Leader and/or medical consultants for further review;

following up with providers to obtain missing claims information or clarify procedure-specific information such as coding and payee;

maintaining online records of all claims activities including contacts made, documentation received and actions taken for future reference; updates group and member addresses;

determining appropriate coordination of benefits where more thanone group contract applies to the claim under review, in accordance with rules and guidelines established through national insurance carrier governing body.

Keys claims data and the results of claims adjudication process into online claims systems; corrects a variety of payment, keying or other errors identified through provider, member or internal audits and makes adjustments to prior payments to reflect new information; makes claims adjustments as requested through Call Centre; processes the re-issue of voided cheques where incorrect payments have been made.

Responds to general inquiries on claims adjudication procedures and system requirements from a variety of internal and external contacts.

General Department and Team Support

Tracks statistical information on claims activities to identify trends in claim types, volumes or other information as requested by the Team Leader or Manager by entering or updating data on existing spreadsheets or checklists.

Reviews and checks a variety of system-generated reports to identify processing variances such as the presence of overrides and duplicate document reference numbers.

Prerequisite Skills and Experience:
High school graduation or equivalent

Keyboarding skills: Minimum keystroking skills of 6,500 ksph

A minimum of one year previous experience working in an office environment

Good command of the English language

Demonstrated ability to perform various administrative function in a high volume environment

Background in Group Health Insurance would be an asset

Pacific Blue Cross is an Employer of Choice offering:
A competitive starting salary of $23.57/hour.

A 35-hour work week; Monday to Friday

Comprehensive paid training

We strive to create a workplace where everyone feels valued and employees feel empowered to freely participate and contribute regardless of race, ethnicity, gender, sexual orientation, religion, ability, education level, parental status, or socioeconomic status. PBC is an equal opportunity employer and welcomes applications from all qualified candidates.

To request an accommodation in completing this application, pre-employment testing, interviewing or otherwise participating in the employee selection process, please direct your inquiries to [email protected]