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Claims Fraud Investigator
3 months ago
If you're someone with a passion for investigating suspected claims fraud and insurance abuse and are wanting to take on a great career opportunity with a local not-for-profit health insurance provider by working with internal and external stakeholders, we want to hear from you.
Your skills in profiling member and provider claims and conducting comprehensive desk investigations will help Pacific Blue Cross be able to provide sustainable healthcare.
Our workplace culture values health and wellness, diversity and equality, continuing education, environmental sustainability and giving back to the community.
Key Ways This Position Makes An Impact
The Claims Fraud Investigator works with the team to review member and provider claims of suspected claims fraud and insurance abuse and actively pursuing recovery of ineligible funds.
This role analyzes cases in order to develop investigative plans that include setting objectives and performance expectations and conducting investigations or desk-based audits, and occasionally in person or via telephone.
In this role, you would gather information and evidentiary material to support findings that follow the evidence chain of custody procedures.
This role would help with putting together file documentation for law enforcement.
Key Experiences You Bring To This Role
- Minimum 3 years' experience in fraud investigation or equivalent experience in reviewing, interpreting and analyzing claims to identify potential areas of fraudulent or insurance abuse claims; preferably in the healthcare insurance field and with a preference to a dental background in either dental claims or working in a dental environment Work in health care, benefits, or insurance
- University degree or technical diploma in a relevant field
- Certified Fraud Examiner designation and/or Investigation Certificate from the Justice Institute is preferred
Together we can create a healthier British Columbia through teamwork, exceptional service and accountability that will help improve sustainable healthcare.
