Claims Oversight & Analytics Manager

GreenShield; Toronto; On-site; CAD 90,000 - 130,000; Full time

Job summary

GreenShield is seeking a strategic Claims Management Manager to build a comprehensive oversight framework for auditing, anomaly detection, and adjudication optimization. Collaborate with finance, pricing, fraud, automation, and product teams to drive cost efficiency and strong member experience.

The role requires 5+ years in claims management or insurance operations, strong analytical skills, and proficiency with SQL, R, Tableau, and Power BI.

Qualifications

• Bachelor’s degree in Finance, Mathematics, Data Analytics, or related field.
• 5+ years of experience in claims management, health benefits, or insurance operations.
• Proficiency in data analysis tools and platforms (SQL, R, Tableau, Power BI).
• Experience with auditing, anomaly detection, and process optimization.

Responsibilities

• Evaluate claims systems and plan designs for gaps; recommend enhancements and authorization criteria.
• Develop dashboards and predictive models for cost drivers and utilization patterns.
• Create reports to support leadership with scenario modeling and insights.
• Perform root-cause analyses to identify adjudication rule gaps and refine rules.
• Collaborate with AR/Billing and fraud teams to align processes and detection.

Skills

Analytical thinking

Data analysis

Cross-functional collaboration

Problem solving

Education

Bachelor's degree in Finance, Mathematics, Data Analytics, or related field

Tools

SQL

R

Tableau

Power BI

Job description

GreenShield is seeking a strategic Claims Management Manager to build a comprehensive oversight framework for auditing, anomaly detection, and adjudication optimization. Collaborate with finance, pricing, fraud, automation, and product teams to drive cost efficiency and strong member experience.

The role requires 5+ years in claims management or insurance operations, strong analytical skills, and proficiency with SQL, R, Tableau, and Power BI.