City : Burnaby

Category : Health Insurance

Industry : Insurance

Employer : Pacific Blue Cross

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.

If you are committed to improving the health and well-being of British Columbians, we are currently recruiting for a EHC Claims Overpayment Collections Administrator to join our Finance team. This role will be working from our head office in Burnaby, BC.

Job Summary

Under the general supervision of the Team Leader, Collections analyzes, investigates and reconciles extended health claims overpayments from various sources, including third party by: reviewing overpayment packages, manually keying relevant information, communicating as required with various stakeholders, researching member claims history, creating invoices to the member, determining if there are alternate recovery sources, creating manual debits and credits, creating spreadsheets to track payment and file activity, and negotiating settlements with members or their lawyers; may write off outstanding overpayments within limits. Reviews various reports to identify variances and takes corrective action; communicates in writing and verbally to a variety of external and internal sources and performs other administrative duties in the support of extended health claims overpayment collections.

Job Duties

Extended Health Claims Overpayment Third Party Collections

• Analyzes, investigates and reconciles extended health claims overpayments from third party sources by:

• Reviewing EHC overpayment claims accident packages received from members to determine if there is a third party liability;

• Manually keying relevant group, member and financial data into system, and opening a file for follow up;

• Communicating as required with member or their lawyer on relevant parts of the group contract, PBC’s policies and terms and conditions;

• Researching member claims history to determine which claims may be related to the accident and which are not;

• Creating invoices to the member at set intervals for those expenses related to the accident where it has been determined a third party liability exists, including explanation for overpayment;

• Creating manual debits and credits as required reconciling payments and deleting the invoice if payment has been received;

• Using the Intermediate features of Excel, creates spreadsheets to track payment and file activity, including such features as sorting and filtering, and manipulating data extracted from Business Intelligence;

• Negotiating settlement amounts and payment schedules with members or their lawyers.

• Within established limits, may write off outstanding extended health overpayments or refer to Team Leader for write off if above authorized limit.

Extended Health Claims Overpayment Administration

• Supports the collection of outstanding extended health claims overpayments by:

• Reviewing a variety of system-generated reports to identify outstanding overpayments and claims paid after cancellation date;

• Manually keying relevant group, member, and financial data into system including posting cheques and void requests to offset overpayments;

• Creating invoices to member or provider at set intervals, including explanation for overpayment;

• Determining if overpayment may be deducted from another group under which the member is actively covered or a future EHC payment.

• Determining if it is possible to retrieve, or void/stop payment the cheque from member if has not yet been cashed. Contacts the member to inform them of this process;

• Creating manual debits and credits as required reconciling payments and deleting the invoice if payment has been received. Reconciles pay-pharmacy cheques where patient overpayments have been created for pay-direct, assures pharmacy is advised and paid for adjustments.

• Within established limits, may write off outstanding extended health overpayments or refer to Team Leader for write off if above authorized limit.

• Reviews system-generated reports to identify variances between outstanding debits and invoices to members. Researches nature of the variance and initiates corrective action by generating invoice to member with explanation.

Customer, Client and Member Service

• Responds to phone, email and written inquiries concerning extended health overpayments procedures, rules and terms and conditions of payment. Clarifies payment rules and requirements for clients, members and providers and reinforces their application.

• Plans the content of and composes a variety of written documents including member and provider letters and emails which adhere to the established standards of business English and internal style guidelines.

General Department and Team Support

• Receives returned mail, determines if updated address can be found through provider, employer or canada411.

• Tracks statistical information on collection activities to monitor productivity and adherence to department service level objectives by entering or updating data on existing spreadsheets or checklists.

• On a one to one basis, supports new employees by demonstrating the execution of specific tasks and duties, and sharing knowledge and experience on request.

• Maintains up to date knowledge of collection rules, policies, procedures, system codes, terminology and other information related to the processing of extended health claims overpayments.

• Performs other assigned duties related to the provision of overpayment claims administration and support which do not affect the rating of the job.

Qualifications:

• High school graduation or equivalent
• Completion of Accounting Level 1 (36 hours or equivalent)
• A minimum of 1 year previous related experience in an Extended Health Claims Benefit Examiner position and/or Customer Service Representative/Call Centre (or equivalent) where on the job group benefits training including extended health benefits has been provided.

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 careers@pac.bluecross.ca