Claims Auditor

5 months ago

Edmonton, Canada Alberta Blue Cross Full time

Alberta Blue Cross® is an Alberta based organization 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 wellness. 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 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, and analyze and report on claims submitted by healthcare 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.
- Experience in the health care benefits industry, Pharmacy industry, and/or audit is desirable.
- 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.

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. If you have the qualifications we are looking for, please apply.

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