Claims Auditor & Investigations Specialist

ABC Benefits Corporation; Alberta; On-site; CAD 65,000 - 90,000; Full time

Job summary

Alberta Blue Cross is seeking a claims audit and investigations professional to develop and execute audit plans, collect documentation, and prepare formal reports. The role emphasizes field work, travel within Alberta, and ensuring compliance with provider agreements and legislation.

Ideal candidates will have investigative interviewing experience, strong communication skills, and the ability to analyze large datasets with Excel.

Qualifications

• Post‑secondary education in science or business, criminal justice, health care and/or law.
• Investigation interviewing experience is an asset.
• Strong written and verbal communication; ability to analyze large data sets in Excel.
• Ability to work independently in a virtual team with accountability.

Responsibilities

• Conduct pharmacy and health audits/investigations and prepare reports.
• Travel within Alberta; collect documentation and perform field work.
• Analyze claims to ensure compliance with agreements, policies and laws.
• Develop working papers and issue reports on claims and monetary adjustments.

Skills

Analytical thinking

Communication skills

Interviewing

Data analysis (Excel)

Independent work

Education

Post-secondary education in science or business, criminal justice, health care and/or law

Tools

Excel

Databases

Job description

Alberta Blue Cross is seeking a claims audit and investigations professional to develop and execute audit plans, collect documentation, and prepare formal reports. The role emphasizes field work, travel within Alberta, and ensuring compliance with provider agreements and legislation.

Ideal candidates will have investigative interviewing experience, strong communication skills, and the ability to analyze large datasets with Excel.