Investigative Review Specialist II

Canada Life; Regina; Hybrid; CAD 44,000 - 75,000; Full time

Job summary

A leading financial services company located in Regina is seeking an Investigative Review Specialist 2 to manage health and dental claims investigations. The role involves data interpretation, investigative planning, and collaboration with a high-performance team. Ideal candidates should have over 2 years of related experience and post-secondary education, with strong problem-solving and communication skills. This hybrid position offers flexible hours and a comprehensive benefits package.

Benefits

Tuition reimbursement

Bonuses

Access to sports leagues

Fitness centre

Comprehensive rewards program

Qualifications

• 2+ years related work experience in an adjudicative, investigative, and/or analytical field or clinic setting.
• In-depth knowledge of health/dental industry practices including coding and billing processes.
• Professional designation in a relevant regulated healthcare field is a plus.
• Ability to communicate in French is considered an asset.

Responsibilities

• Conduct thorough case investigations identified through various detection channels.
• Develop and execute the investigative plan in a timely manner.
• Work closely with team members including investigators and data analysts.
• Accurately document investigative actions and outcomes according to department policy.

Skills

Problem solving

Communication skills

Analytical skills

Customer service mindset

Organization skills

Education

Post-secondary education (degree/diploma)

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Job description

Permanent Full Time

We are currently hiring for an Investigative Review Specialist 2 – Fraud Management (DPIS), Workplace Benefits & Retirement with a focus on health & dental benefits.

Are you a naturally curious problem solver with health and dental experience? If so, we are seeking an investigator with health & dental experience to join our high-performance team. This role would be a key member of a team that delivers robust and effective health and dental claims fraud prevention to Canada Life customers.

After completing an internal training program, the Investigative Review Specialist 2 will apply their knowledge and experience to conduct complex health & dental investigations. While working closely with their leader, the Investigative Review Specialist 2 will determine investigative next steps by assessing case information and claims details and then contact providers, clinics or plan members to validate services to ensure that claims are free from suspicion of fraud or abuse. Taking into consideration the evidence and other information gathered, the Investigative Review Specialist 2 will propose and execute recommendations to resolve the case, proceed with recovery efforts or refer to special investigations.

To be successful in this role, you must possess superior written and verbal communication, problem solving and organization skills to ensure the accurate documentation of the investigation.

This is a hybrid position – the successful applicants will be required to work 3 days a week in office with flexible working hours within our core business hours of 7am-5pm.

What you will do:

• Conduct thorough case investigations identified through various detection channels
• Understand and interpret data from various sources
• Develop and execute the investigative plan in a timely manner to obtain evidence where fraud or abuse is suspected by contacting (verbal and/or written) appropriate parties, including plan member, claimant and/or provider
• Work closely with other members of the team including investigators, data analysts and the Special Investigations unit
• Consult with Health and Dental subject matter experts, medical review board and/or consultants, regulatory bodies, Legal or other internal departments as warranted by the case
• Accurately document investigative actions and outcomes according to department policy
• Where evidence supports an action, determine and execute the appropriate action according to established protocols
• Create comprehensive reports regarding investigative findings to support criminal, recovery, civil or labour relations actions as needed
• Communicate case information as necessary according to established protocols
• Identify fraud and abuse risks and make recommendations to mitigate future risk
• Collaborate on special projects as assigned including targeted investigations, department process innovations and system enhancements
• Participate in training and mentorship opportunities to other members of the team
• Keep current on industry trends and maintain appropriate professional development

What you will bring:

• 2+ years related work experience in an adjudicative, investigative, and/or analytical field or clinic setting
• In-depth knowledge of health/dental industry practices and procedure including coding and billing processes
• Completion of post-secondary level education (e.g. university or college degree/diploma)
• A combination of relevant experience and education will be considered
• Professional designation in a relevant regulated healthcare field (Dental Hygiene, Dental Assistant, Healthcare) would be considered an asset
• Solution oriented with strong decision-making, problem-solving skills and analytical skills
• Strong customer service mindset
• Excellent communication skills, both verbal and written, in fast-paced and unscripted situations
• Excellent organizational and time management skills; able to manage multiple, simultaneous investigations and re-prioritize as priorities change
• Demonstrated proficiency using Microsoft applications such as Excel, Word and Outlook.
• Ability to communicate in French is considered an asset
• Workplace Solutions Operations knowledge (including legacy systems) would be an asset
• Due to the high profile of a number of our clients, a Federal Government Enhanced Screening is a job requirement which will involve fingerprinting and a credit check
• Reliability Status Security Clearance – this can only be completed with candidates who receive an offer of employment. This is a personal security status that is required as a condition of employment before an employee can gain access to Protected B information, assets or work sites as outlined by the Government of Canada website. The cost of submitting these checks will be covered by Canada Life.

Benefits:

• Opportunities to carry out challenging work in a dynamic, collaborative and fast-growing team
• Leaders who support your development in a friendly, supportive work environment
• A competitive and comprehensive rewards program including tuition reimbursement, bonuses and flexible benefits
• Paid vacation, personal days and employee volunteer day allotmentThe opportunity to participate in a variety of teambuilding activities and professional development activities that help to strengthen your skills and build strong relationships within the department and company
• Access to various sports leagues such as hockey and indoor soccer, an on-site fitness centre and cafeteria

The base salary for this position is between $44,900.00 - $74,800.00 annually. This represents base salary only and does not represent other variable compensation components of our total compensation ( i.e. annual bonus, commission etc). If you are selected to move forward in our recruitment process, your recruiter will be able to discuss additional details of our total rewards program with you.

Career opportunities will be open a minimum of 5 business days from the date of posting, closing dates will vary depending on the search activity. All applications received will be reviewed on a rolling basis.

Be your best at Canada Life- Apply today!

Being a part of Canada Life means you have a voice. This is a place where your unique background, perspectives and talents are valued, and shape our future success.

You can be your best here. You’re part of a diverse and inclusive workplace where your career and well-being are championed. You’ll have the opportunity to excel in your way, finding new and better ways to deliver exceptional customer and advisor experiences.

Together, as part of a great team, you’ll deliver on our shared purpose to improve the well-being of Canadians. It’s our driving force. Become part of a strong and successful company that’s trusted by millions of Canadians to do the right thing.

Canada Life serves the financial security needs of more than 13 million people across Canada, with additional operations in Europe and the United States. As members of the Power Financial Corporation group of companies, we’re one of Canada’s leading insurers with interests in life insurance, health insurance, investment and retirement savings. We offer a broad portfolio of financial and benefit plan solutions for individuals, families, businesses and organizations.

We are committed to providing an inclusive, accessible environment, where all employees and customers feel valued, respected and supported. We are dedicated to building a workforce that reflects the diversity of the communities in which we live, and to creating an environment where every employee has the opportunity to reach their potential.

It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will work with applicants who request a reasonable accommodation during the application process. All information shared during the accommodation request process will be stored and used in a manner that is consistent with applicable laws and Canada Life policies. To request a reasonable accommodation in the application process, contact [e-mail].

Canada Life would like to thank all applicants, however only those who qualify for an interview will be contacted.