We’re a Manitoba-based, not-for-profit, health benefits provider with a vision to be the trusted and essential health and wellness partner for all Manitobans. Every dollar made is reinvested in our infrastructure, our people, and our province with the goal of providing better care for our members, expanding our community impact and broadening our health care knowledge.
Why work for us?
Manitoba Blue Cross, is a Manitoba Top Employer. We are empowered to give back to the community, and we know that caring needs to start in our workplace with our own Manitoba Blue Cross team. We actively foster a culture that focuses on your satisfaction, development, diversity, and growth.
Culture of Caring
We strive to succeed at reaching our organizational goals, but we always make time to celebrate our successes. Having fun as a group and rewarding our employees for their accomplishments is an essential part of our workplace culture.
We want our workforce to reflect the diverse community we serve, and we're committed to creating a fair and respectful workplace. We offer a work environment that promotes a healthy work-life balance and support to advance your career that includes:
- Competitive starting salary.
- A comprehensive health benefit package.
- Hybrid work environment, flexible work schedules.
- Fully equipped onsite fitness center.
- Casual dress code to promote diversity and inclusivity.
- Personal and professional development.
POSITION SUMMARY
The Claims Representative opens and sorts Claims department mail, verifies claim forms for completeness, assists with other department correspondence, assesses, adjudicates and processes standard and diverse Health Spending Account, Ambulance and Hospital, Health and Dental Benefit claims in an accurate and timely manner. The incumbent must work well independently as well as in a team setting.
DUTIES AND RESPONSIBILITIES
- Responsible for the organization of claims mail and correspondence received in the claims department.
- Opens, screens claims for required information, date stamps, sorts and manages Claims department mail within production standards.
- Maintains claims received counts for production reporting.
- Adjudicates and processes standard and diverse Extended Health, Prescription Drug, Vision and Dental claims in accordance with performance standards
- Communicates with members and providers during the course of claims assessment.
- Adjudicates and processes claims for coordination of benefits.
- Assists in the management of the Claims Workplace as assigned.
- Assist with adjudication of medical claims.
- Processes claims for groups with Service Level Agreements within the standards set out in the agreement.
- Returns claims for completeness of information and obtains any necessary additional information from both members and providers.
- Assists members and providers with claiming procedures.
- Processes bonds and returned cheque requests.
- Manages and updates Coordination of Benefits (COB) information received from Customer Services and Client Services.
- Maintains production report and weekly claim count.
- Performs other related duties as assigned
- Dedicated to the principles of exceptional service; committed to responding to, anticipating and addressing customer needs for both internal and external customers. Capable of communicating effectively with subscribers and providers in a professional manner.
- College Diploma or equivalent combination of education and 1-2 years’ related experience.
- Strong computer skills including Word, Excel and e-mail software.
- Strong problem solving, analytical and numerical abilities.
- Excellent interpersonal and communication skills.
- Excellent organizational skills with the ability to manage and prioritize several activities on an ongoing basis.
- Ability to work independently as well as in a team setting.
- Ability to learn and use MBC applications relevant to the Claims department.
- Previous claims adjudication experience and/or experience in the health field an asset.
- Knowledge of pharmacy and medical products, dental and their terminology an asset.
- Completion of medical administrative assistant certificate courses an asset.
- Capable of completing industry education programs entailing a self-directed study and the writing of graded examinations. Specific programs include but are not limited to LOMA, CEBS and ICA. Enrollment in, and completion of, such courses will be encouraged.
- Overtime may be required during peak periods.
If you would like to join our team, you are invited to apply by submitting your resume and cover letter by clicking the "Apply" button below by August 25, 2025.
To learn more visit: https://www2.mb.bluecross.ca/about-us/careers
We appreciate the interest expressed by all applicants and acknowledge the effort put into the application process, however only those selected for an interview will be contacted.
Manitoba Blue Cross is committed to the principles of diversity, equity & inclusion and to promoting opportunities in hiring for everyone. We want our workforce to reflect the diverse community we serve, and we're committed to creating a fair and respectful workplace.
We encourage all qualified candidates to apply. If you require an accommodation during the hiring process, please let us know.
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