Organization: Ministry of Health Division: Health Programs and Delivery Division

Language of Position(s):
Bilingual English/French
Job Term: Permanent
Job Code: 09OAD - Office Administration 09
Salary: $28.14 - $32.82 Per hour* *Indicates the salary listed as per the OPSEU Collective Agreement.
Understanding the job ad - definitions
Posting Status: Open
Job ID: 240166

Join our Hamilton team as a Claims Assessor and make a real impact on the lives of Ontario healthcare providers and the public.
As a Claims Assessor, you'll play a crucial role in supporting the Ministry of Health's healthcare delivery strategies. You'll utilize analytical and research skills and medical knowledge to
authenticate, resolve, and facilitate the payment of claims for Ontario healthcare benefits. Learn more about the Ministry of Health's Mandate and Programs

Job Location

119 King St W, Hamilton, West Region

Responsibilities

In a highly confidential work environment, you will: • use your research skills to assess and analyze claims making payment decisions within strict deadlines • investigate and respond to complex claims inquiries by communicating effectively, offering clear concise explanations related to claims payment decisions, policy, and associated legislation • work cooperatively in a team sharing information, and providing input

Qualifications

Mandatory requirements
You must possess oral French language skills at the advanced level. Your proficiency level will be confirmed before hire.
Knowledge:
• ability to understand medical terminology and human anatomy to read and understand operative and emergency reports • ability to understand, interpret and apply policies, work within guidelines, procedures and legislation to process claims and protect information and determine its disclosure
Research and Analytical Skills:
• ability to evaluate and resolve claims • ability to determine appropriate payment • ability to apply discretion and judgement to confirm eligibility for programs, determine when to escalate contentious issues/claims and resolve 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:
• ability to provide detailed and understandable explanations on work processes and claims payments to internal and external clients • 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 • 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

Base Salary

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

Work Hours

Fulltime

Benefits

What we offer
The Ontario Public Service is one of Ontario's largest employers. Employees work for a wide range of 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 • tailored work arrangements, including opportunities like flex hours, self-funded leave and more

This permanent 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 • vacation and leave options • an Employee and Family Assistance Program, which provides confidential counseling services • a dynamic and supportive work environment • opportunities for professional growth and development

Apply Now
Posted:

 

How to apply:
1. You must apply online.
2. Your cover letter and resume combined should not exceed five (5) pages. For tips and tools on how to write a concise cover letter and resume, review the Writing a Cover Letter and Resume: Tips, Tools and Resources.
3. Customize your cover letter and resume to the qualifications listed on the job ad. Using concrete examples, you must show how you demonstrated the requirements for this job. We rely on the information you provide to us.
4. Read the job description to make sure you understand this job.
5. OPS employees are required to quote their WIN EMPLOYEE ID number when applying.
6. If you require a disability related accommodation in order to participate in the recruitment process, please Contact Us to provide your contact information. Recruitment services team will contact you within 48 hours.

Please be advised that the results of this competition may be used to form an eligibility list of qualified candidates to potentially fill future vacancies represented by the Ontario Public Service Employees Union (OPSEU). In accordance with the Collective Agreement, eligibility lists are shared with OPSEU representatives. By applying to this competition, you are providing consent that your name may be shared with OPSEU representatives.
All external applicants (including former employees of the Ontario Public Service) applying to a competition in a ministry or Commission public body must disclose (either in the cover letter or resume) previous employment with the Ontario Public Service. Disclosure must include positions held, dates of employment and any active restrictions as applicable from being rehired by the Ontario Public Service. Active restrictions can include time and/or ministry-specific restrictions currently in force, and may preclude a former employee from being offered a position with the Ontario Public Service for a specific time period (e.g. one year), or from being offered a position with a specific ministry (either for a pre-determined time period or indefinitely). The circumstances around an employee’s exit will be considered prior to an offer of employment.
Remember:
The deadline to apply is Tuesday, February 17, 2026 11:59 pm EST. Late applications will not be accepted. We thank you for your interest. Only those selected for further screening or an interview will be contacted.
The Ontario Public Service is an inclusive employer. Accommodation is available under the Ontario’s Human Rights Code .

 

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