Claims Assessor

Environment, Conservation and Parks | Environnement, Protection de la nature et Parcs; Hamilton; On-site; CAD 39,000 - 44,000; Full time

Benefits offered by this job

Defined-benefit pension plan

Health, dental, life and disability"

Vacation and leave options

Employee and Family Assistance Program

Job summary

Ontario Public Service in Hamilton is seeking a Health Claims Administrator to assess and adjudicate medical claims, analyze payment irregularities and respond to inquiries within tight deadlines. You will initiate payments and adjustments while protecting confidential information for providers and the public.

The role emphasizes accurate interpretation of policies, strong research skills, and the ability to manage competing priorities in a busy government environment.

Qualifications

• Demonstrated knowledge of medical terminology and human anatomy to read and understand operative and emergency reports.
• Proven ability to understand, interpret and apply policies, work within guidelines, procedures and legislation to process claims and protect information and determine its disclosure.

Responsibilities

• Use your research skills to assess claims and analyze payment irregularities within strict deadlines.
• Respond to inquiries.
• Initiate payments, adjustments or recoveries.
• Provide service to medical providers and the public.
• Deal with confidential and sensitive medical and personal information.

Skills

Medical terminology

Human anatomy

Claims processing policies

Discretion and judgement

Customer service

Tools

Mainframe software

Job description

Apply By:Monday, October 19, 2026 11:59 pm EDT

Health Programs and Delivery Division - Claims Services Branch

City:

Hamilton

Position(s) language:

Job term:

1 Permanent

Job code:

09OAD - Office Administration 09

$28.14 - $32.82 Per hour*
*Indicates the salary listed as per the OPSEU Collective Agreement.

Come join our dynamic team of professionals in Hamilton!
Do you have an interest in providing timely, accurate and cost effective delivery of claim services to health care providers and the public? If so, bring your knowledge of medical terminology, human anatomy and your ability to authenticate, adjudicate and facilitate payment of claims for health care benefits to our team!

About the job

You will:

• Use your research skills to assess claims and analyze payment irregularities within strict deadlines.
• Respond to inquiries.
• Initiate payments, adjustments or recoveries.
• Provide service to medical providers and the public.
• Deal with confidential and sensitive medical and personal information.

What you bring to the team

Knowledge:

• Demonstrated knowledge of medical terminology and human anatomy to read and understand operative and emergency reports.
• Proven ability to understand, interpret and apply policies, work within guidelines, procedures and legislation to process claims and protect information and determine its disclosure.

Research/analytical skills:

• Ability to evaluate and adjudicate stakeholder claims.
• Ability to determine appropriate payment.
• Proven ability to apply discretion and judgement to confirm eligibility for programs, determine when to elevate contentious issues/claims and adjudicate payment as applicable.

Organizational skills:

• Ability to organize and manage own workload, process a high volume of claims and inquiries within strict timeframes.

Tact, diplomacy and communication skills:

• Demonstrated ability to provide detailed and understandable explanations (oral and written) on work processes and claims payments to internal and external clients.
• Demonstrated interpersonal skills to interact with clients and team members and to understand and respond appropriately to issues, dealing with conflict situations and/or with sensitive medical/financial information.
• Demonstrated experience working cooperatively in a team to meet deadlines and organization goals and assisting in the training of new and existing employees.

Mathematical and computer skills:

• Ability to calculate fees, recognize billing irregularities and reconcile payments and adjustments.
• Working knowledge of personal computers, mainframe applications, software (e-mail, word processing, internet, databases) and keyboarding skills to input/access/retrieve information and create correspondence and reports.

Don't meet every qualification?

If you are excited about this position and meet most, but not all, of the listed qualifications, please still consider applying. We recognize that no one person might have every qualification in this job ad, and you just might be the right candidate!

How we support diversity, inclusion and accessibility

We are building an inclusive workforce that reflects the communities we serve. We encourage everyone interested in working with us to apply, including people with disabilities, Indigenous, Black and racialized individuals, as well as people from all ethnicities, cultures, sexual orientations, gender identities and gender expressions.

Our hiring process is accessible, consistent with Ontario's Human Rights Code and the Accessibility for Ontarians with Disabilities Act, 2005. We are working to prevent and remove barriers in our hiring processes and can offer accommodation to address specific needs related to Code-protected grounds such as disability, family status and religion. For more information about accommodation during the hiring process please contact us.

Learn more about the work the OPS is doing to create an inclusive, anti-racist, accessible and diverse workplace:

• diversity, equity and inclusion initiatives
• accessibility
• Anti-Racism Policy

What we offer

The Ontario Public Service is one of Ontario's largest employers. Employees work for 29 ministries, with offices in more than 70 cities across the province. We offer:

• a career that can grow across ministries and job functions
• flexible learning and developmental opportunities, including education and mentorship programs
• many employee networks offering support for and education about underrepresented groups

This role comes with a comprehensive compensation and benefits package that includes:

• a defined-benefit lifetime pension plan (guaranteed, ongoing inflation-protected income after retirement)
• group health, dental, life and disability benefits
• a range of vacation and leave options
• an Employee and Family Assistance Program, which provides confidential counseling services

Additional information:

Apply by:

Monday, October 19, 2026 11:59 pm EDT

• 1 English Permanent - Full Time, 119 King St W, Hamilton, West Region, Criminal Record Check
• About security checks: A criminal or other federal offence record does not automatically disqualify you from the position. We consider each situation based on the position's responsibilities. If a check is needed and you've lived outside of Canada in the past 5 years for 6 or more months in a row, or if you are not a Canadian resident, you'll need to provide an out-of-country police clearance certificate from the country you lived in. Employment screening checks are only reviewed and evaluated by the Transition and Security Office, which also maintains them and keeps them strictly confidential.

Language requirements and assessment: All external Ontario Public Service (OPS) job ads are posted in English and French. Check the "position(s) language" section at the top of each job ad for the language requirements. For all roles, candidates are assessed in English, the business language of the OPS. If the position is bilingual (English/French), you'll also need to pass a French-language proficiency test.