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Audit Investigator
4 months ago
For over 75 years, Medavie Blue Cross has been a leading health and wellness partner for individuals, employers and governments across Canada. As a not-for-profit organization, we proudly invest in communities to help address some of Canada’s most pressing health care challenges. We are one of Canada's Most Admired Corporate Cultures, one of Canada’s Top 100 Employers, Canada’s Life & Health Insurer of the Year for 2021 and an Imagine Canada Caring Company.
Our 2,400 professionals work across six provinces, united by our shared values of being caring, accountable, responsible, innovative and community-minded. We’re committed to ensuring our employees thrive in our award-winning, collaborative culture focused on ensuring health, wellness, and personal and professional growth through a variety of programs and support across our organization.
Together with Medavie Health Services, we are part of Medavie - a national health solutions partner with over 7,700 employees. Our mission is to improve the wellbeing of Canadians.
Job Title: Audit Investigator Department: Finance and Treasurer Competition: 87131 Internal/External: Both Employment Type: Full Time Permanent Location: Remote in Atlantic Canada or Ontario Salary: Competitive Compensation Package Reports To: Team Leader Closing Date: June 16, 2024
The Opportunity
We currently have an opening for an accountable, self-directed individual to join the Federal Provider Audit unit as an Audit Investigator. In this role, your accountabilities will include applying audit and analytical tools and techniques in the review for abnormal claiming patterns among healthcare providers of our company’s drug, hospital, extended-health and dental benefit programs. You will be required to maintain constant and efficient communication with service providers and customers.
Key Responsibilities
- Planning, performing, and leading claims audits and other investigative engagements in a manner consistent with audit and fraud examination industry best-practices;
- Applying query analytics and expert software to profile for indicators of inappropriate claims submissions by healthcare providers;
- Performing audits of providers and plan members including: pre-audit and post-audit work; determining the most appropriate course of action based on your findings; compiling findings; and completing final case reports in a manner that is presentable to management, law enforcement agencies and/or other regulatory bodies as required;
- Summarizing findings, recommendations, and corrective actions in written reports;
- Building, developing and maintaining strong relationships with colleagues and customers, to encourage open dialogue and collaborative commitment to problem solving, continuous improvement, and corporate risk mitigation;
- Maintaining a commitment to ongoing learning, developing audit skills in line with best-practice, and building a strong foundation in insurance and healthcare industry principles and knowledge;
- Leading and assisting in the performance of other unique risk-based projects;
- Occassionally traveling within Canada to conduct on-site audits.
Qualifications
- Knowledge of audit principles, practices and methodologies acquired preferably through 1-3+ years of experience in auditing and/or investigative practices;
- Relevant post-secondary education is required. A professional designation in fraud detection, auditing or investigative techniques (e.g. CPA, CA, CMA, CGA, CIA, CFE, etc.) or professional experience in a healthcare field would be considered an asset;
- Experience in the use of data analytics software (e.g. ACL, Excel, etc.), along with an ability to learn and apply statistical inference and data sampling principles to large data populations;
- Excellent initiative, problem solving and analytical skills;
- Ability to work well with a team and collaborate both internally and with external stakeholders and management;
- Ability to articulate thoughts in a clear and concise manner (both verbal and written);
- Ability to manage multiple competing priorities and tight deadlines;
- Demonstrated computer skills (including word processing, spreadsheets, flowcharts, etc.);
- Financial Services experience would be an asset, preferably within the insurance and/or healthcare industry;
- Professional experience in a healthcare field will also be considered (Nursing Assistants, Dental assistants, Vision Care, etc.);
- Ability to tavel within Canada, as well as a valid driver’s license.
#CBM1
We are an Equal Opportunity Employer.
Medavie Blue Cross strives to foster a culture where everyone is enabled to achieve their full potential - a culture of diversity, equity and inclusion (DEI) where we live our values every day in the way we treat each other, our members and the communities we serve. Accessibility is a top priority.
For applicants with disabilities, we provide accommodations throughout the recruitment, selection and/or assessment process. If selected to participate in the recruitment, selection and/or assessment process, please inform Medavie Blue Cross Human Resources staff of the nature of any accommodation(s) that you may require in respect of any materials or processes used to ensure your equal participation. All personal information is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act.
We would like to thank all candidates for expressing interest. Please note only those selected for interviews will be contacted.
