Clerk 3 (OPOP/OPIP Claim Coordinator)

About Us

The Department of Health and Wellness offers opportunities to grow and advance in a dynamic sector that touches the lives of all Nova Scotians. Along with our partners, including the Nova Scotia Health Authority and the IWK Health Centre, we’re committed to continually improving our health care system. With a focus on collaborative primary health care, improved supports for mental health and addictions, digital health, capital infrastructure, and more, the department is thinking differently about how to plan, fund, legislate and monitor to improve access and service delivery. To do this, we need leaders at all levels of the organization who embrace a challenge and believe in their ability to make a difference.

About Our Opportunity

As a Health Claims Clerk, you will play an important role in supporting the administration of out-of-province healthcare claims for Nova Scotia residents.

Working as part of the Benefits Eligibility team, you will review, process, and reconcile healthcare claims submitted by hospitals and health organizations across Canada. You will help ensure that claims are assessed accurately, payments are processed correctly, and inquiries are handled professionally and efficiently.

This position is well suited to someone who enjoys detailed administrative work, problem solving, working with financial information, and providing excellent service to both internal and external clients.

Primary Accountabilities

In this role, you will:

• Review out-of-province outpatient hospital claims for accuracy and completeness.
• Process claims and maintain records using specialized billing and tracking systems.
• Verify eligibility for Nova Scotia health coverage and assess claim requirements.
• Investigate discrepancies, adjustments, and billing issues.
• Communicate with healthcare organizations, government partners, and residents regarding claim eligibility and reimbursement processes.
• Prepare payment documentation and support financial reconciliation activities.
• Record and maintain accurate claim and payment information for reporting and statistical purposes.
• Process refunds, payment adjustments, and replacement payment requests.
• Respond to inquiries from healthcare providers, government partners, and members of the public.
• Assist with program reporting, special projects, and administrative support activities.
• Contribute ideas and recommendations that improve processes, service delivery, and system effectiveness.
• Provide backup support for  mail pick up and distribution, and other team functions as required.

Qualifications and Experience

To be successful in this role, you have at least 4 years related experience performing administrative work that requires a high degree of accuracy and attention to detail in a computerized accounting environment; or an

equivalent combination of training and experience may be acceptable.

You demonstrate:

• Experience reviewing, processing, and maintaining records, financial transactions, or claims-related information.
• Strong analytical and problem-solving skills with the ability to investigate discrepancies and resolve issues.
• Experience working with computerized databases, financial systems, or record management systems.
• Strong written and verbal communication skills.
• Proven ability to manage multiple priorities while maintaining accuracy and confidentiality.
• Processing health-related claims, benefits, insurance, or reimbursement transactions.
• Working with financial reconciliation, accounts payable, or payment processing.

The following experience is considered an asset:

• working within the healthcare sector, public service, or a regulated environment.
• Knowledge of reciprocal billing programs or health coverage administration.

We will assess the above qualifications and competencies using one or more of the following tools: written examination, standardized tests, oral presentations, interview(s), and reference checks.

Equivalency

We recognize equivalent combinations of training, education, and experience, providing opportunities for individuals with diverse backgrounds to contribute their skills and expertise. Equivalencies include, but are not limited to:

• Completion of a 1 year related diploma and 3 years of related experience
• Completion of a 2 year related diploma and 3 years of related experience
• Completion of a related Bachelors degree.

Applicants relying on education and experience equivalencies must demonstrate such equivalencies in their application. 

Benefits

Based on the employment status and union agreement, the Government of Nova Scotia offers its employees a wide range of benefits such as a Defined Benefit Pension Plan, Health, Dental, Life Insurance, General illness, Short and Long Term Disability, Vacation and Employee and Family Assistance Programs.  For information on all our Benefit program offerings, click here: Benefits for government employees.

Working Conditions

Your typical work week is 35 hours with 7-hour days. This position is office-based and involves regular computer work and data entry. The role requires sustained attention to detail and accuracy when reviewing claims, processing payments, and maintaining records. You will work with multiple sources of information and regularly communicate with healthcare organizations, government partners, and members of the public.

At times, you may be required to manage competing priorities, respond to inquiries, and meet operational deadlines while maintaining a high level of client service.

What We Offer

• Career Development where you have access to career guidance, tools, resources, and ongoing training for every stage of your career
• Engaging workplace: our Employees feel valued, respected, connected, and tuned in, we have forward-thinking policies and strategies
• Countless career paths