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Manager, Investigations - Claims Audit and Investigation Services

Audit

|

Edmonton

|

Permanent Full Time

Date posted

August 3, 2022

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 and investigations of health care providers and plan members to assure compliance with provider agreements, group contracts, policies, procedures, applicable legislation, and Alberta Blue Cross controls. The investigation team’s main responsibility is to identify and investigate fraud, and report on the investigation findings that were submitted by health care providers and members. Working in a mobile work style arrangement, this position will monitor, coach, develop, and support the investigation team.  The successful candidate will have exemplary investigation skills, proven leadership capacity, excellent written and verbal communication skills, strong problem-solving ability, change management skills and outstanding commitment to providing excellent service. 

WHAT YOU WILL DO:

  • Act as the primary resource for your assigned team, monitor investigation turnaround times, and ensure investigation and reporting meet all required standards.
  • Proactively address 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 the Investigation Team including monitory workload management, ensuring individuals meet production goals, coaching and mentoring (encouraging individual development), completion of performance agreements, and addressing performance issues.
  • Establish and continuously enhance best practices guidelines for the successful delivery of the investigation. 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 strategic initiatives.

WHAT YOU WILL HAVE:

  • A post-secondary degree preferably in science or business
  • An audit or investigation designation such as ACFI or ACFE is required
  • 10 + years’ experience in investigations
  • 5+ years’ experience leading people.
  • Demonstrate strong analytical, investigative, and logical thinking skills with the ability to solve complex problems.
  • Exceptional communication skills, including written and verbal. Experienced in investigation interviewing.
  • Proven track record of being organized, committed to accuracy, and detailed.
  • Ability to influence other and move toward a common vision or goal.
  • 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.

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 confirm their COVID-19 vaccination status and may be required to provide proof of a valid negative COVID-19 test or a valid exemption pursuant to applicable human rights law if not fully vaccinated.

 

Join our team

Date posted

August 3, 2022

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.