Medical Benefits Enquiries Customer Service Representative Regular Full-time

About PBC Solutions:

PBC Solutions has been recognized as one of British Columbias Top Employers for 2025!

PBC Solutions Ltd. was created in 2022 as a wholly owned subsidiary of PBC Health Benefits Society (operating as Pacific Blue Cross) #1 health benefits provider in BC. Our mandate is to design transform and deliver the benefits and claims administration services offered by governments and other large organizations along with our consortium partners DXC Advanced Solutions NTT DATA and EY.

Since the spring of 2023 PBC Solutions administers and leads the transformation and digitization of Health Insurance BC Services (HIBC) on behalf of the BC Ministry of Health. HIBC Services administers medicallynecessary insured doctor and hospital services through the Medical Services Plan (MSP) and drug coverage through the PharmaCare and Fair PharmaCare programs. In the future the business will expand to additional public and private client work.

Position Summary

The Medical Benefits Enquiries Customer Service Representative (CSR) reviews researches and responds to enquiries within a call centre environment. Calls can regard medical benefits claims submissions payments for healthcare professionals hospitals clinics laboratories and the general public. This work involves reviewing and discussing patient and practitioner information so therefore requires an extremely high level of privacy adherence accuracy and professionalism.

The CSR explains claims rules as published within the Medical Services Commission Payment Schedule and provincial healthcare policies. In order to discuss a claim with a caller CSRs often need to have a fair understanding of medical terminology and have a logical approach to problem solving.

This position is designated as a Grid level 14 with an hourly range of of $32.20 $36.65.

Primary Duties

• Articulate client policies clearly neutrally and quickly
• Assist callers in the use of online 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
• 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

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 requests for medical histories

• Validate information and documents provided by public
• Make decisions on and initiates reimbursements directly to beneficiaries
• 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 PBCS 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 noncompliance 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
• Deescalate emotionally charged situations/calls
• Utilize prosocial skills (sharing taking turns manners negotiation problem solving smiling impulse control interrupting/listening dealing with mistakes making decisions etc.
• Other duties as assigned

Required Education and Experience

• High school diploma or GED equivalent including a 65 grade in Grade 12 English and Math required may be subject to standardized testing
• Intermediate level of the MS Office Suite applications
• Minimum 1 year of experience working in a call centre environment providing customer service practicing protection of privacy and information and the ability to communicate in a professional manner orally and in writing.
• An equivalent combination of education and experience may be considered.

Required Competencies

• Effective Communication
• Managing Diverse Relationships
• Organizational Savvy
• Multiple Demands and Time Management
• Conflict Management
• Customer Focus
• Balancing Stakeholders
• Decision Quality

Whats in it for you
We offer a robust health & dental benefits plan with flexible options that will meet you and your familys needs. We also offer a Defined Benefit Pension Plan (PSPP) for all eligible employees as well as various generous paid leaves.

We strive to create a workplace where everyone feels valued and employees feel empowered to freely participate and contribute regardless of race ethnicity gender or gender identity sexual orientation religion ability education level parental status or socioeconomic status.

PBC Solutions is an equal opportunity employer and welcomes applications from all qualified candidates.

To request an accommodation in completing this application preemployment testing interviewing or otherwise participating in the employee selection process please direct your inquiries to

Does this opportunity resonate with you
Are you seeking a work environment that will challenge you provide stretch opportunities and support your success and growth Then youve found your ideal work environment Apply today please! Wed love to talk with you to explore this opportunity further with you.

Please note if selected for this opportunity you will be required to undergo a background check in accordance with PBC Solutions policies.

We sincerely thank all candidates for their interest however only those selected to continue in the recruitment process will be contacted.

Please apply by April 22 2025 by 4:00 PM PST. An eligibility list may be established for this position.

How we work

Our Guiding Principles

Honesty We will be truthful. We will create a safe environment to communicate proactively openly and with respect. We will be transparent and genuine with our interests.

Integrity We will act consistently to do the right thing and ensure our words and actions align. Embracing opportunities and challenges we will live our shared values and vision.

Reciprocity We will strive for fair and balanced exchanges leveraging our unique strengths and resources recognizing this requires an ongoing give and take. We will win and lose as one.

Autonomy We respect and acknowledge the interests of each party. We trust each other to make decisions and act based on our diverse strengths to achieve our mutually desired outcomes.

Loyalty We will be bold brave and committed to our relationship. As partners we will advocate for one another celebrate our successes and have each others back through our challenges.

Equity We commit to a balanced partnership. We will make decisions and act based on a fair assessment of capabilities risks constraints and opportunities to achieve mutual success.

Our Intended Behaviours

Communication We actively communicate in a timely open respectful and responsive manner with the intent to gain understanding and find solutions.

Flexibility We will be agile adaptable and creative to enable responsive service delivery and embrace challenges and change with an openminded and positive attitude.

Perspective We seek to understand interests assumptions actions and diverse backgrounds by actively sharing and exploring all points of view.

Focus We will use our Shared Vision as our North Star to evaluate prioritize and deliver successful results.

Trust & Confidence We lead with trust. We consistently behave in ways that earn and inspire confidence by being credible reliable and transparent even when vulnerable.

Feedback No surprises. We will maintain a strong relationship through timely purposeful feedback in a safe respectful and collaborative environment.

Solutionoriented We see possibilities rather than limitations. We use our diverse capabilities to develop options to resolve our challenges.