Claims Fraud Investigator

About Pacific Blue Cross Pacific Blue Cross (PBC) has been British Columbia's leading benefits provider for over 80 years. We are an independent, not‑for‑profit society with strong roots in BC’s health care system. We provide health, dental, life, disability, and travel coverage to 1 in 3 British Columbians through employee group plans and individual plans. We are fueled by a commitment to keep health care sustainable for all British Columbians, and through our PBC Health Foundation we fund projects that improve mental health and wellbeing and chronic disease prevention and management. We offer an attractive compensation and benefits package and a workplace culture that values health and wellness, diversity and equality, continuing education, environmental sustainability, and community giving back. Perks Flexible working hours of 7.5 hours per day, Monday to Friday (i.e., 37.5 hours per week). Paid vacation starts at 4 weeks per year, and increases with years of service. Hybrid work environment (combination of work from office and work from home). Generous benefits, including extended health, dental, and life insurance; depending on the plan you choose, these premiums can be 100% paid by PBC. PBC contributes the equivalent of 8% of your base salary to a Defined Contribution pension plan. No employee contribution or matching is required. Onsite gym, cafeteria, and access to virtual doctors/counsellors 24/7 via our Employee Family Assistance Program. About the Position We are searching for a permanent Claims Fraud Investigator to join our Fraud Investigations team. This role is currently working hybrid from home and from our head office in Burnaby, BC. The typical hiring range for this position is $68,000 – $82,000 per year, with a starting salary determined based on skills, education, experience, and internal equity. As part of our total rewards package you’ll be eligible for our annual bonus program. Responsibilities Profile member and provider dental and extended health claims and conduct comprehensive investigations of suspected claims fraud and insurance abuse. Analyze and evaluate cases to develop investigative plans. Gather information and evidentiary material to support findings, following evidence‑chain‑of‑custody procedures. Prepare comprehensive reports that include evidence findings, results, and recommended recovery actions and amounts. Participate in the preparation of file documentation for regulatory bodies and/or law enforcement. Key Experiences You Bring To This Role Bachelor’s degree in Criminology, Business, or an equivalent discipline. Certified Fraud Examiner certification or equivalent. 3 – 5 years of related experience in fraud investigation or similar experience in reviewing, interpreting and analyzing extended health claims to identify potential areas of fraudulent or insurance abuse. Advanced Excel skills (complex data manipulation, statistical analysis, filtering and advanced use of formulas and functions). Preferred and Considered Assets Knowledge of the Health Professions Act. Application Please apply via our website this week at http://www.pbchbs.com/company/careers/. While we thank all applicants for their interest, only short‑listed candidates will be contacted. Diversity, Equity, and Inclusion PBC is an Indigenous Works employer of choice, an Insurance Business Canada Diversity, Equity, and Inclusion award winner, one of Canada’s Greenest employers, a Canadian Centre for Diversity and Inclusion (CCDI) employer partner, and a Pride at Work partner. We strive to create a workplace where everyone feels valued and employees feel empowered to freely participate and contribute regardless of race, ethnicity, gender, sexual orientation, religion, ability, education level, parental status, or socioeconomic status. We are an equal‑opportunity employer and welcome applications from all qualified candidates. To request an accommodation in completing this job application, testing, interviewing, or otherwise participating in the employee selection process, please direct your inquiries to careers@pac.bluecross.ca. These accommodation requests will be reviewed confidentially and on a case‑by‑case basis by Human Resources. #J-18808-Ljbffr