Investigation Coordinator – Claims Audit & Investigation Services

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.

OVERVIEW:

Claims Audit and Investigation Services conducts audits and investigations of dental and health care providers and plan members to assure compliance with provider agreements, group contract, polices procedures, and applicable legislation. The Audit and Investigations teams’ main responsibility is to identify and investigate fraud and /or non-compliance to relevant billing agreements, and report on the investigation findings related to dental and health benefits claims.

Working in a hybrid work style arrangement within a team environment, this position will be responsible for obtaining evidence to substantiate claims and supporting other investigators within the team.  You will be reviewing documentary evidence and making inquiries with health providers and members. You must have excellent written and verbal communication skills, strong analytical and problem-solving ability, and outstanding commitment to providing excellent service.

WHAT YOU WILL DO:

• Review documentary evidence to support audits and investigations of dental and health care providers and plan members claims.

• Complete claims analysis to assure compliance with contracts, policies, procedures and applicable legislation.

• Prepare working papers, letters, and reports.

• Issue reports on claims and /or monetary adjustments and changes in practice to facilitate compliance.

WHAT YOU WILL HAVE:

• Post-secondary education preferably in science or business.

• Experience in the health care benefits industry, and audit and/or investigation are desirable.

• Exceptional communication skills, including written and verbal.

• 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 analysis 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/or other health care benefits industry is desirable.

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