Bilingual Claims Verification Analyst

3 months ago

Montréal QC, Canada Manulife Full time

The Claims Verification Analyst is responsible for supporting health and dental claims fraud risk controls by authenticating claim submissions, identifying, and investigating issues for action and resolution, and escalating key control issues to the claims risk management team.

The Claims Verification Analyst will conduct health and dental claims audits by reviewing receipt evidence and supporting documentation, contacting providers and/or plan members to validate submissions, verifying provider licensing through internet searches and contact with professional associations and colleges, and following through on actions from these reviews for successful outcomes. The auditor will work with our various internal departments including Technical Services, Customer Service, Investigation Services and H&D Operations for the resolution of claims submission issues.

**Responsibilities**
- Reviews audit evidence submissions by plan members to authenticate information, identifies areas of concern, and action issues for resolution, and obtains/requests additional evidence required on suspect claim submissions.
- Validates irregular Internet transaction activity through phone call interviews with providers and/or plan members and secures evidence on discrepancies as part of information gathering on suspect claim submission activity. Requests supporting documentation from plan members and authenticates information, identifying issues and gaps for further review and resolution.
- Identifies fraudulent claims, documents and gathers evidence, and supports ongoing management of investigation activity
- Confirms provider licensing credentials and legitimate business establishments through Internet searches and by contact with professional associations and colleges. Actions and resolves issues for successful audit outcomes and escalates key provider control issues to the e-commerce control management team
- Analyzes data to identify anomalies, trends and patterns; and supports testing and documentation of new risk controls for continuous review of all Internet submission activity
- Supports awareness of e-commerce control and operational workflow issues by providing direction and information to internal Group Benefit departments such as the Call Center and various Health and Dental Operation departments

**How will you create impact?**

The Claims Verification Analyst reports to the Program Manager, Investigation Services, and helps to protect plan sponsors and members from the negative impacts of claims fraud. This role is focused on risk detection, which is the foundation for our investigation programs and a vital part of claims risk management.

**What motivates you?**
- You obsess about customers, listen, engage and act for their benefit.
- You think big, with curiosity to discover ways to use your agile approach and enable business outcomes.
- You thrive in teams and enjoy getting things done together.
- You take ownership and build solutions, focusing on what matters.
- You do what is right, work with integrity and speak up.
- You share your humanity, helping us build a diverse and inclusive work environment for everyone

**What we are looking for**
- **Bilingual (French & English) is required**:

- Excellent written communication skills
- Ability to manage contentious interactions with various stakeholders and take control of stressful situations with tact and diplomacy
- Excellent oral communication skills and ability to interview service providers, plan members and others for successful audit outcomes
- Resourceful with a proven analytical, problem-solving, and troubleshooting background
- Proficient in research and quick decision-making
- Knowledge of privacy, civil and criminal legal risks, and processes
- Strong organizational skills and the ability to manage multiple conflicting priorities in a fast-paced changing environment as well as adapt to changes is essential
- Ability to take action on ideas, situations, or opportunities before being asked
- Ability to be skeptical, probing, creative and aggressive in conducting authentication and investigation activity

**What can we offer you?**
- A competitive salary and benefits package.
- A growth trajectory that extends upward and outward, encouraging you to follow your passions and learn new skills.
- A focus on growing your career path with us.
- Flexible work policies and strong work-life balance.
- Professional development and leadership opportunities.

**Our commitment to you**
- **Values-first culture**:We lead with our Values every day and bring them to life together.
- **Boundless opportunity**:We create opportunities to learn and grow at every stage of your career.
- **Boundless opportunity**:We invite you to help redefine the future of financial services.
- **Delivering the promise of Diversity, Equity and Inclusion**:We foster an inclusive workplace where everyone thrives.
- **Championing Corporate Citizenship**:We build a business that benefits all stake

  • Bilingual analysts

    4 days ago

    Montréal, QC, Canada Huntel Global Full time

    Bilingual Workday Analyst Location: Long Term Contract Join a rock-solid organization as our client’s next Bilingual Workday Analyst and sit at the center of projects that drives decisions. You’ll help one of Canada's most trusted organizations work on the latest project, and be rewarded with great opportunities. Participate in the...

  • Bilingual (French/English) Analyst

    4 days ago

    Montréal, QC, Canada Huntel Global Full time

    Bilingual Workday Analyst Location: Long Term Contract Join a rock-solid organization as our client’s next Bilingual Workday Analyst and sit at the center of projects that drives decisions. You’ll help one of Canada's most trusted organizations work on the latest project, and be rewarded with great opportunities. Participate in the...

  • Bilingual (English/french) Data Entry Analyst

    5 months ago

    Montréal, QC, Canada Procom Full time

    Au nom de notre client dans le secteur bancaire, PROCOM recherche un Analyste de saisie de données bilingue (anglais/français), Hypothèques (MS Excel) Analyste de saisie de données bilingue (anglais/français), Hypothèques (MS Excel) - Description du poste - Département : Prêts personnels - Impression et signature de documents - Traitement des...

  • Bilingual (French/english) Verifications Specialist

    1 week ago

    Montréal, Canada Sterling Backcheck Corp. Full time

    As a Bilingual Verifications Specialist, you will conduct reference interviews, employment verifications and education verifications on behalf of our clients. **What you will do**: - Conduct reference interviews on behalf of clients. - Make and be available to receive calls for references and/or verifications - Provide client care and respond to...

  • Bilingual Workday Analyst

    4 days ago

    Montréal, QC, Canada Huntel Global Full time

    Title: Bilingual Workday Analyst Location: Montreal, ON, Canada (Hybrid) Type: Long Term Contract Introduction: Join a rock-solid organization as our client’s next Bilingual Workday Analyst and sit at the center of projects that drives decisions. You’ll help one of Canada's most trusted organizations work on the latest project, and be rewarded...

  • Bilingual Workday Analyst

    4 days ago

    Montréal, QC, Canada Huntel Global Full time

    Title: Bilingual Workday Analyst Location: Montreal, ON, Canada (Hybrid) Type: Long Term Contract Introduction: Join a rock-solid organization as our client’s next Bilingual Workday Analyst and sit at the center of projects that drives decisions. You’ll help one of Canada's most trusted organizations work on the latest project, and be...

  • Claims Analyst

    5 days ago

    Montréal, Canada Medavie Full time

    Type de poste:PermanentÀ la recherche d’une carrière épanouissante qui changera réellement votre vie et celle des autres? Vous êtes au bon endroit.À titre de partenaire national en solutions de santé, nous plaçons les gens au cœur de tout ce que nous faisons - en commençant par notre équipe de plus de 8 000 employés et employées qui mettent à...

  • Claims Analyst

    6 days ago

    Montréal, Canada Medavie Full time

    Type de poste:PermanentÀ la recherche d’une carrière épanouissante qui changera réellement votre vie et celle des autres? Vous êtes au bon endroit.À titre de partenaire national en solutions de santé, nous plaçons les gens au cœur de tout ce que nous faisons - en commençant par notre équipe de plus de 8 000 employés et employées qui mettent à...

  • Bilingual Claim Adjudicators

    4 days ago

    Montréal, Canada Manulife Full time

    **_Are you looking for a supportive, collaborative workplace with great teams and inspiring leaders? You’ve come to the right place. We’re looking for ambitious people who share our values and want to make every day better for people around the world. If this sounds like you, and the career below sounds exciting, we’d like to hear from you....

  • Bilingual Claims Adjudicators

    4 days ago

    Montréal, Canada Manulife Full time

    **_Are you looking for a supportive, collaborative workplace with great teams and inspiring leaders? You’ve come to the right place. We’re looking for ambitious people who share our values and want to make every day better for people around the world. If this sounds like you, and the career below sounds exciting, we’d like to hear from you....

  • Expert en Sinistre

    2 months ago

    Montréal, QC H1V 1A6, Canada Marsh McLennan Agency Full time

    At Marsh McLennan Agency / Vézina assurance, we believe every day brings new opportunity. Opportunity to grow, succeed, and thrive. With the right employer to help you realize your full potential, the future is truly limitless! **Responsibilities**: - Manage medium to high complexity claims for all insurance lines (Property, General civil liability,...

  • Claims Analyst

    7 months ago

    Montréal, Canada Intertape Polymer Group (IPG) Full time

    **Claims Analyst **Position Purpose**:This position adjudicates all Customer Disputes or Claims in accordance with IPG business guidelines and respective Policies and Procedures. **Principle Accountabilities** - Validate and process customer claims such as returns, shortages, pricing discrepancies in a timely manner - Analyze and review claims file...

  • Bilingual Creditor Claims Analyst

    7 months ago

    Montréal, Canada Securian Canada Full time

    **Who we need** The **Bilingual Creditor Claims Analyst** will be accountable to assess claims for benefit entitlement by adhering to contractual, medical, functional, and occupational information to render claim decisions according to contract and established processes. This function includes key accountabilities that require strong commitment to quality...

  • Claims Analyst

    1 week ago

    Montréal, Canada IPG, Intertape Polymer Group Full time

    **Claims Analyst** **Position Purpose**:This position adjudicates all Customer Disputes or Claims in accordance with IPG business guidelines and respective Policies and Procedures. **Principle Accountabilities** 1. Validate and process customer claims such as returns, shortages, pricing discrepancies in a timely manner 2. Analyze and review claims file...

  • Bilingual Representative, Claims

    3 months ago

    Montréal, QC, Canada Definity Financial Corporation Full time

    Petline is part of Definity, which includes some of Canada’s most long-standing and innovative insurance brands, including Economical Insurance, Sonnet Insurance, Family Insurance Solutions, and Petline Insurance. Our ambition is to be one of Canada’s leading and most innovative property and casualty insurers. We can’t do that without our people, so we...

  • Bilingual Investigation Analyst

    7 months ago

    Montréal, Canada Manulife Full time

    We are a leading financial services provider committed to making decisions easier and lives better for our customers and colleagues around the world. From our environmental initiatives to our community investments, we lead with values throughout our business. To help us stand out, we help you step up, because when colleagues are healthy, respected and...

  • Bilingual Disability Claims Analyst

    5 days ago

    Montréal, Canada Royal Bank of Canada Full time

    **Come Work with Us!** At RBC, our culture is deeply supportive and rich in opportunity and reward. You will help our clients thrive and our communities prosper, empowered by a spirit of shared purpose. Whether you’re helping clients find new opportunities, developing new technology, or providing expert advice to internal partners, you will be doing work...

  • Bilingual Occupational Health and Safety Analyst

    7 months ago

    Montréal, Canada LifeWorks Full time

    TELUS Health and LifeWorks have recently come together to leverage the power of technology and our caring cultures to further progress our shared goal of building a healthier and friendlier future for all. As a global-leading health and well-being provider - encompassing physical, mental and financial health - TELUS Health is improving health outcomes for...

  • Claims Advisor

    7 months ago

    Montréal, Canada BFL Canada Full time

    Job Details Description **We offer more than a job, we offer a career!** - We support our employees to shape their careers by encouraging continuing education and investing in training and development. - We put our employees at the center of what we do to allow them to grow personally and professionally, with projects and challenges that are motivating and...

  • Bilingual Group Benefits Analyst

    5 months ago

    Montréal, QC, Canada Canada Life Assurance Company Full time

    Bilingual Group Benefits Analyst **Description: - Permanent Full Time**Role Description**: - Shatter your perception of a traditional insurance company. We’re looking for skilled career individuals to join a creative organization where you’ll connect with some of the most entrepreneurial, upbeat, high-energy people you’ll ever meet in your life.- It...