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Compliance Analyst (Health and Dental) Claims Audit & Investigation Services

Audit

|

Edmonton

|

Permanent Full Time

Date posted

October 27, 2021

Closing date

December 24, 2021

Let’s impact lives for the better!

Alberta Blue Cross® is Alberta based, not-for-profit and 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 the wellness of all Albertans. 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 employees to maintain a healthy work-life balance and provide opportunities for training and career growth.

OVERVIEW:

Claims Audit and Investigation Services conducts audits of health care providers and plan members to assure compliance with provider agreements, group contracts, policies, procedures, applicable legislation, and Alberta Blue Cross®  controls. This position offers the opportunity to work with a team dedicated to accuracy and detail. The main responsibility of this position is to complete audits, analyze and report on claims submitted by health care providers and members.

WHAT YOU WILL DO:

  • Complete on-site visits and special projects to collect information and documentation.
  • Complete claims analysis to assure compliance with provider agreements, group contracts, policies, procedures, applicable legislation, and Alberta Blue Cross controls.
  • 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.
  • Follow the team’s policies, procedures, and quality standards.
  • Participate in internal department process reviews and make recommendations for process improvements.
  • 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

WHAT YOU WILL HAVE:

  • A post-secondary degree preferably in science or business. Related experience may also be considered.
  • Demonstrate strong analytical, investigative, and logical thinking skills with the ability to solve complex problems.
  • Excellent interpersonal and communication skills. Experience in investigation interviewing skills would be an asset.
  • Proven track record of being organized, committed to accuracy, and detailed.
  • Exhibit commitment to teamwork and be willing to learn and adapt to changing priorities.
  • Capacity to work on multiple projects, prioritize, and meets deadlines.
  • Demonstrate self-direction with a strong sense of responsibility and accountability.
  • Proficient in Microsoft Word and Excel. 
  • Experience in the health care benefits industry and/or audit is desirable.

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 employees by welcoming, respecting and valuing their unique perspectives, backgrounds and experiences.

We offer a competitive salary and benefits package and the opportunity to work in an innovative, high-energy team-focused environment. This position will remain open until a suitable candidate is selected.  If you have the qualifications we are looking for, apply online at
careers.ab.bluecross.ca


COVID-19 Vaccination Notice: Alberta Blue Cross® has a COVID-19 Vaccination Policy that applies to all of its employees.  As a condition of employment, successful job applicants will be asked to: (a) confirm their COVID-19 vaccination status and provide proof they are fully vaccinated*, OR (b) produce a valid negative COVID-19 test** on an ongoing basis, at their cost, completed within 72 hours of working at any Alberta Blue Cross workplace starting December 15, 2021. Successful candidates who cannot be fully vaccinated on the basis of a protected legal ground (i.e., medical condition/ disability; religious belief) may request exemption and accommodation. 

 

*Fully vaccinated means having received all of the recommended number of doses of a COVID-19 vaccine, or a combination of COVID-19 vaccines, approved by Health Canada to produce an immune response to COVID-19 (i.e., at least two doses of a two-dose vaccine, or one dose of a single-dose vaccine) and at least 14 days have lapsed since the date on which the person received the last of the  recommended doses.

**Heath Canada approved tests (PCR and point of care antigen test) administered by a health care professional (at home test kits are not acceptable).


Join our team

Date posted

October 27, 2021

Apply

About us

Let’s impact lives for the better!

Alberta Blue Cross® is Alberta based, not-for-profit and 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 the wellness of all Albertans. 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 employees to maintain a healthy work-life balance and provide opportunities for training and career growth.