Investigator – Claims Audit & Investigation Services

Alberta Blue Cross; Edmonton; On-site; CAD 70,000 - 90,000; Full time

Job summary

A health services organization in Canada is seeking an experienced investigator to conduct audits and ensure compliance within the health care benefits industry. The ideal candidate will have 3-5 years of investigative experience, strong communication skills, and a commitment to exceptional customer service. This role requires post-secondary education and may consider relevant experience in lieu of education. Join a diverse and inclusive team dedicated to providing outstanding service.

Benefits

Career growth opportunities

Innovative team-focused environment

Supportive workplace culture

Qualifications

• 3 - 5+ years’ experience in investigations.
• Knowledge of databases and ability to analyze large amounts of data.
• Experience in dental and health care benefits industry is preferable.

Responsibilities

• Conduct dental and/or health audits and investigations.
• Complete claims analysis for compliance with provider agreements.
• Develop and maintain good relationships with service providers.

Skills

Exceptional communication skills

Analytical skills using Microsoft Excel

Commitment to quality customer service

Education

Post-secondary education in science or business

Investigative designation (CFI or CFE)

Job description

Overview

Alberta Blue Cross is an Alberta-based organization dedicated to delivering exceptional customer experience and community leadership. We’re committed to providing the best health coverage to over 1.8 million members and take an active role in promoting wellness. We believe in what we do—and place trust in our employees to deliver our vision. Working at Alberta Blue Cross means having a career where you’ll be recognized for your contributions. We value diversity, encourage our team members to maintain a healthy work-life balance and provide opportunities for career growth.

Responsibilities

• Conduct dental and / or health audits / investigations, and ensure investigation and reporting meet all required standards.
• Field work to collect documentation is a key aspect of this role. Travel is required within Alberta (a valid Class 5 Driver's License is required).
• Complete claims analysis to assure compliance with provider agreements, group contracts, policies, procedures, applicable legislation.
• Prepare working papers, letters, and reports.
• Issue reports on claims and / or monetary adjustments and changes in practice to facilitate compliance.
• Develop and maintain good relationships with service providers and internal partners.
• Proactively address internal and external clients’ needs that are escalated to you and help to prioritize work items to meet client service standards.
• Recommend changes to processes, policies, and procedures to optimize service delivery and enhance productivity.

Qualifications

• Post-secondary education in science or business, criminal justice, health care and / or law. Relevant experience in law enforcement can be considered in lieu.
• An investigative designation such as CFI, or CFE is preferable (candidates with extensive relative experience will be considered in lieu of education).
• 3 - 5+ years’ experience in investigations.
• Exceptional communication skills, including written and verbal. Experienced in investigation interviewing.
• Commitment to quality customer service is required for success in this position. This includes the ability to establish and maintain effective working relationships with both internal and external customers.
• Knowledge of databases and ability to analyze large amounts of data using Microsoft Excel.
• Ability to work well independently as part of a virtual team, with a strong sense of responsibility and accountability.
• Experience in the dental and health care benefits industry such as a registered dental assistant or other related health discipline is preferable.

This position will remain open until a suitable candidate is selected.

Alberta Blue Cross is an inclusive employer committed to a workplace that reflects the diversity of the communities we serve. We empower and are advocates for our team members by welcoming, respecting and valuing their unique perspectives, backgrounds, and experiences.

We offer the opportunity to work in an innovative, high-energy team-focused environment. If you have the qualifications we are looking for, apply online at careers.ab.bluecross.ca

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