Claims Coordinator (FT) in Midland

Waypoint Centre for Mental Health Care is a 321-bed academic and teaching hospital that provides specialized mental health, addiction and geriatric care. Located on the shores of Georgian Bay, we serve some of the most complex and disadvantaged individuals in Ontario and are the sole provider of high-secure forensic mental health services in the province.

Waypoint Centre for Mental Health Care is currently seeking a Full-Time Claims Coordinator. The purpose of the position is to support the effective administration, coordination and tracking of Waypoint's insurance claims f rom initial identification and notification through closure. The position maintains an accurate and confidential register of active and potential claims, coordinates timely reporting to Waypoint's insurer s , and facilitates the exchange of information between Waypoint, management, legal counsel, insurers, adjusters and other authorized partners.

The position is responsible for maintaining effective administrative processes, systems and reporting mechanisms to support consistent and efficient claims administration. This includes maintaining an electronic claims tracking system, related workflows, documentation standards and reporting tools in collaboration with relevant internal partners.

Please Note: This position offers a hybrid work environment consisting of in-office and remote work. Office location is 500 Church Street.

KEY ACCOUNTABILITIES:

Your key responsibilities will include, but are not limited to

Claims Administration and Coordination:

• Maintains Waypoint's register of actual and potential claims and ensures information is accurate, current and appropriately documented.
• Coordinates the registration and timely submission of actual and potential claims to Waypoint's insurer and supports ongoing administrative management throughout the claim's lifecycle, including tracking status, Reporting and response deadlines, limitation dates identified by legal counsel or the insurer, outstanding information, required follow-up, next steps and closure.
• Coordinates the collection and organization of information and documentation required to support claims, insurers and legal counsel and follows up on outstanding information and action items, escalating matters requiring management attention.
• Liaises with insurers, adjusters, legal counsel and internal partners to obtain and communicate administrative updates relating to claims, and coordinates the scheduling of claim-related meetings and calls, as required.
• Maintains appropriate documentation of claim-related communications, follow-up activities and status updates, and prepares routine and ad hoc claims reports, summaries and status updates for management.

Legal and External Stakeholder Coordination:

• Serves as a coordination point for administrative matters involving legal counsel, insurers, adjusters and other external stakeholders, coordinating requests for information, supporting the preparation and organization of records and information requested in connection to claims.
• Escalates matters requiring legal advice, management direction or professional judgment to the appropriate individual, coordinates meetings and calls involving legal counsel, and ensures appropriate management/leadership participation where legal advice is being sought or provided.
• Communicates administrative information and follow-up requirements to appropriate internal partners.

Claims Tracking System and Process Development:

• Supports the developments, implementations and maintenance an electronic system for tracking actual and potential claims, supporting documentation, status, deadlines, follow-up requirements and reporting. Collaborates with relevant internal partners to define system and process requirements, strengthen information security and accessibility, and identify opportunities for continuous improvement as organizational needs evolve.
• Establishes standardized administrative workflows, processes, templates and documentation practices to support consistent claims administration, and develops and maintains tracking tools, reports and dashboards to support monitoring of claims and outstanding actions.
• Identifies opportunities to improve the efficiency, consistency, accessibility and security of claims information and administrative processes, and supports the ongoing maintenance and improvement of claims systems and processes as organizational requirements evolve.
• Provides support and guidance to internal partners regarding established claims processes and systems, as required.
• Maintains documentation relating to claims processes, workflows and system requirements.

Reporting and Information Management:

• Ensures claims information is entered, updated and maintained in accordance with established procedures, and maintains accurate and organized records relating to claims.
• Prepares regular and ad hoc reports and summaries relating to active and potential claims, and supports the preparation of information required by Waypoint's insurer and other authorized external parties.
• Monitors the claims register to identify outstanding information, follow-up requirements, approaching deadlines and other administrative matters requiring attention. Identifies data or documentation gaps and follows up with appropriate internal partners.
• Periodically reviews and reconciles the claims register against information received from insurers, adjusters and legal counsel; resolves administrative discrepancies; documents changes; and supports internal reviews, audits and other authorized reporting requirements.

Confidentiality and Privacy:

• Handles highly sensitive and confidential information relating to patients, clients, staff, legal matters and the organization. Escalates questions regarding the appropriate handling or disclosure of confidential labour relations information to Human Resources and questions regarding the appropriate handling or disclosure of confidential patient or organizational information to the Privacy Officer.
• Maintains records in accordance with established privacy, security, retention and information-management requirements, ensuring confidentiality and security of information.
• Exercises discretion regarding access to, use of and disclosure of highly confidential and sensitive information, including information relating to patients, employees, legal matters, labour relations, workplace matters, investigations and other sensitive organizational matters. Maintains strict confidentiality and ensures information is accessed, used and disclosed only in accordance with established requirements.

REQUIREMENTS/QUALIFICATIONS:

• Diploma or degree in business administration, health administration, legal administration, records/information management or a related field OR an equivalent combination of relevant post-secondary education and experience is required.
• Minimum of three years of related administrative, coordination, claims, legal or information management experience is required.
• Experience in a healthcare or other complex organizational environment is preferred.
• Familiarity with Healthcare Insurance Reciprocal of Canada (HIROC) processes is considered an asset.
• Results oriented work ethic to work independently and undertake tasks needed to accomplish work objectives and deliver quality, consistent and timely results
• Excellent written and verbal communication skills
• Models and promotes core ethical practice, Waypoint Values (Caring, Respect, Accountability, Innovation)
• Preference for proficiency in French/English language skills.

WHAT WE OFFER:

• A comprehensive and generous benefit plan including dental coverage, paid holidays, paid vacation days, sick days and extended health benefits
• Participation in the Health Care of Ontario Pension Plan (HOOPP)
• Professional development and mentorship opportunities
• Relocation support program for eligible staff
• Participation in the employee referral program for eligible staff
• Access to Waypoint's Employee & Family Assistance Program (EFAP)