Jobs at Alberta Blue Cross

Processes manual and high-cost pharmacy claims, performs quality assurance and claim adjustments, supports pharmacy providers with submissions and reversals, conducts system testing, researches complex inquiries, tracks work initiatives, and reports on productivity. The role requires accuracy, customer service, organization, problem-solving, adaptability, and proficiency with Microsoft Office. Occasional flexible hours and a satisfactory criminal record check are required.

Leads claims audit, investigation, fraud risk management, prevention, and education programs for a health benefits organization. Develops multi-year strategies, oversees risk-based audits and investigations, strengthens controls, partners with providers, regulators, and law enforcement, and reports findings to senior leadership and Board committees. Uses analytics and artificial intelligence to identify risks and improve case selection. Manages and develops the investigation and claims audit team while ensuring fairness, confidentiality, compliance, and continuous improvement.

Owns target architecture and modernization roadmaps for assigned technology or business portfolios. Translates enterprise strategy into architecture guidance, transition states, sequencing recommendations, investment options, and governance-ready decisions. Assesses impacts across capabilities, applications, data, integrations, security, operations, customer experience, regulatory obligations, and delivery readiness. Influences senior stakeholders and delivery teams without direct authority while surfacing risks, dependencies, trade-offs, technical debt, and deviations from target architecture.

Provides enterprise-wide architectural leadership for data and AI, defining principles, standards, reference architectures, roadmaps, and governance guardrails. Advises executives and architecture teams on platform decisions, modernization, risk, privacy, security, regulatory alignment, and responsible AI adoption. Oversees major initiatives to improve consistency, reuse, data quality, and long-term sustainability across hybrid legacy and modern environments.

Lead and perform operational, financial, compliance and governance audits, contribute to CSAE 3416 and ICOFR programs, design and test controls, report findings, liaise with stakeholders and external auditors, and coach audit staff to improve control effectiveness and processes.

Respond to telephone inquiries from pharmacies and healthcare providers about benefit eligibility, claim adjudication, plan limits and prior approvals. Verify claims using online adjudication systems, log call details, provide provider support, suggest workflow improvements, and assist with projects and analyses using Excel and Word.

Lead strategic business development to grow Individual Products through affinity partnerships, B2B2C alliances, channel diversification, retiree conversion programs, and market intelligence. Manage pipeline, collaborate cross-functionally, and present executive-level pitches to drive revenue and expand distribution for health, dental, travel, and wellness products.

Collect, clean, validate and extract financial and operational data; build reports, models, and analytics to support FP&A decision-making; collaborate on data pipelines, governance, automation, and system enhancements; maintain financial data models and ensure data quality.