Teams 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.