Team Manager, Claims Audit – 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 investigation 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 developing an audit investigation plan, executing the audit, and creating the final report. You must have experience with interviewing and investigation, excellent written and verbal communication skills, strong analytical and problem-solving ability, and outstanding commitment to providing excellent service.

WHAT YOU WILL DO:

• Act as the primary resource for your assigned team, monitor audits and investigations, and ensure audits and investigations, including all reporting meet all required standards.

• Proactively address internal and external clients’ needs that are escalated to you and help your team to prioritize work items to meet client service standards.

• Responsible for the management of the day-to-day activities of team members including workload management, audit and/or investigative direction, coaching and mentoring.

• Establish and continuously enhance best practices guidelines for the successful delivery of the audits and investigations. This will serve as the framework for the professional development of team members.

• Maintain a positive, collaborative team which inspires high productivity and encourages the generation of new ideas and enhanced work processes.

• Recommend and implement changes to processes, policies, and procedures to optimize service delivery and enhance productivity.

• Recruit, train, mentor, and coach team members, with an end goal of retaining a work force of the highest quality for both the team and our organization.

• Actively participate in the planning and implementation of Claims Audit and Investigation Services operational initiatives.

WHAT YOU WILL HAVE:

• Post-secondary education preferred in police studies, criminal justice, law, commerce, or related studies.

• Comprehensive understanding of major case management principles.

• Ability to employ and train advanced investigative techniques.

• An audit or investigation designation such as ACFI or ACFE is required (candidates with extensive relative experience will be considered in lieu of education).

• Five years plus experience in investigations and/or auditing.

• Three years plus leadership experience is an asset.

• 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.

• Ability to work well independently as part of a virtual team, with a strong sense of responsibility and accountability.

• Experience in the 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