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.

• 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

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.)

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

• An eligibility list may be established for this role.
• This is a temporary Assignment
• This position may become permanent.
• This position is based in our office in downtown Victoria, BC.
• This position is required to be in office for a minimum of three-months of training with a move to three days per week in office after training is complete.
• 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.