Claims Fraud Investigator

Brainhunter Systems Ltd; Burnaby; Hybrid; CAD 68,000 - 82,000; Full time

Job summary

An established industry player is seeking dedicated Claims Fraud Investigators to join their dynamic Fraud Investigations team. This role involves investigating potential fraudulent claims, analyzing data, and preparing comprehensive reports to support recovery efforts. With a strong commitment to health and wellness, the organization offers a hybrid work environment and a competitive compensation package, including generous benefits and a pension plan. If you are passionate about making a difference in the community and have a background in fraud investigation, this is an exciting opportunity to grow your career in a supportive and inclusive workplace.

Benefits

Flexible working hours

Paid vacation starting at 4 weeks

Hybrid work environment

Generous benefits including health and dental

Defined Contribution pension plan

Onsite gym

Cafeteria

Access to virtual doctors/counsellors

Qualifications

• 3-5 years experience in fraud investigation or analyzing health claims.
• Bachelor’s degree in Criminology or equivalent discipline required.

Responsibilities

• Investigate member and provider dental and health claims for fraud.
• Prepare reports with findings and recommended recovery actions.

Skills

Fraud Investigation

Data Analysis

Report Writing

Communication Skills

Education

Bachelor’s degree in Criminology

Certified Fraud Examiner certification

Tools

Advanced Excel

Job description

Pacific Blue Cross (PBC) has been British Columbia's leading benefits provider for over 80 years. We are an independent, not-for-profit society with strong roots in BC’s health care system. We provide health, dental, life, disability, and travel coverage to 1 in 3 British Columbians through employee group plans and individual plans.

We are fueled by a commitment to keep health care sustainable for all British Columbians. Through our PBC Health Foundation, we fund projects that improve health outcomes directly related to mental health and wellbeing as well as the prevention and/or management of chronic disease. We are interested in finding people who want to make a difference and who are looking to grow their career with us.

We offer an attractive compensation and benefits package. Our workplace culture values health and wellness, diversity and equality, continuing education, environmental sustainability and giving back to the community.

• Flexible working hours of 7.5 hours per day, Monday to Friday (i.e., 37.5 hours per week).
• Paid vacation starts at 4 weeks per year, and increases with years of service.
• Hybrid work environment (i.e., a combination of work from office and work from home days).
• Generous benefits, including extended health, dental, and life insurance; depending on the plan that you choose, these benefit premiums can be 100% paid by PBC.
• PBC contributes the equivalent of 8% of your base salary to a Defined Contribution pension plan. No employee contribution or matching is required, giving you more take-home pay.
• Onsite gym, cafeteria, and access to virtual doctors/counsellors 24/7 via our Employee Family Assistance Program!

About the Position

• We are searching for two (2) permanent Claims Fraud Investigators to join our Fraud Investigations team.
• PBC’s compensation program is built on a pay-for-performance philosophy, rewarding both individual and organizational achievements. The typical hiring range for this position is $68,000 - $82,000 per year, with the starting salary determined based on a combination of skills, education, experience, and internal equity. As part of our total rewards package, you’ll be eligible for our annual bonus program.

Are you ready to take on a role that is responsible for investigating member and provider dental and extended health claims? If so, we want to hear from you! This is a unique opportunity to work on potential fraudulent claims and pursue recovery of eligible funds to directly contribute to the health and well-being of our community.

This role is currently working hybrid from home and from our head office in Burnaby, BC. Apply this week if you would like to take on this role.

Key Ways This Position Makes An Impact

As a Claims Fraud Investigator, you will work on profiling member and provider dental and extended health claims and conducting comprehensive investigations of suspected claims fraud and insurance abuse, including activity to pursue recovery of ineligible funds.

In this role, you would analyze and evaluate cases in order to develop investigative plans to execute.

You would gather information and evidentiary material to support findings that follow the evidence chain of custody procedures.

In this role, you would be preparing comprehensive reports that include evidence findings, results, and recommended recovery actions and amounts.

As a Claims Fraud Investigator, you would participate in the preparation of file documentation for regulatory bodies and/or law enforcement.

Key Experiences You Bring To This Role

• Bachelor’s degree in Criminology, Business, or an equivalent discipline.
• Certified Fraud Examiner certification, or equivalent.
• 3 – 5 years of related experience in fraud investigation or similar experience in reviewing, interpreting and analyzing extended health claims to identify potential areas of fraudulent or insurance abuse.
• Advanced Excel (complex data manipulation, statistical analysis, filtering and advanced use of formulas and functions).

It’s preferred and considered an asset if you have:

• Knowledge of the Health Professions Act.

If you’re excited about taking on this opportunity, we invite you to apply today and start the conversation with us about this position.

While we thank all applicants for their interest, only short-listed candidates will be contacted.

Diversity, Equity, and Inclusion

PBC is an Indigenous Works employer of choice, an Insurance Business Canada Diversity, Equity, and Inclusion award winner, one of Canada’s Greenest employers, a Canadian Centre for Diversity and Inclusion (CCDI) employer partner, and a Pride at Work partner.

We strive to create a workplace where everyone feels valued and employees feel empowered to freely participate and contribute regardless of race, ethnicity, gender, sexual orientation, religion, ability, education level, parental status, or socioeconomic status. We are an equal opportunity employer and welcome applications from all qualified candidates.

To request an accommodation in completing this job application, testing, interviewing, or otherwise participating in the employee selection process, please direct your inquiries to [e-mail]. These accommodation requests will be reviewed confidentially and, on a case-by-case basis by Human Resources.