Claims Fraud Investigator
1 week ago
**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. Through our PBC Health Foundation, we fund projects that improve health outcomes directly related to mental health and wellbeing as well as the prevention and/or management of chronic disease. We are interested in finding people who want to make a difference and who are looking to grow their career with us.
**Perks**
- Work-life balance with 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 (i.e., a combination of work from office and work from home days).
- Generous benefits, including extended health, dental, and life insurance; depending on the plan that you choose, these benefit premiums can be 100% paid by PBC.
- Company pension contributions after 1 year of service.
- Education allowance to expand your knowledge and develop your skills.
- 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.
- PBCs compensation offerings are grounded in a pay-for-performance philosophy that recognizes exceptional individual and team performance. The typical hiring range for this position is $62,000- $82,000 per year; the base pay offered is based on market and may vary depending on job-related knowledge, skills, experience, and internal equity. The starting salary will be determined based on a combination of skills, education, and experience.
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 audits and investigations will help Pacific Blue Cross be able to provide sustainable healthcare.
We offer an attractive compensation and benefits package and work-life balance. 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 pursue recovery of ineligible funds.
This role analyzes cases, work with large sets of claims data and develops investigative plans to conduct investigations and/or desk audits, and occasionally in person.
In this role, you would gather information and evidentiary material to support findings that follow the principles of administrative law.
You would prepare comprehensive reports that include evidence findings, results, and recommended recovery actions and amounts.
This role would help with putting together file documentation for referral to regulatory, civil or criminal consideration.
**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.
Together we can create a healthier British Columbia through teamwork, exceptional service and accountability that will help improve sustainable healthcare.
- _
-
Claims Fraud Investigator
3 months ago
Burnaby, Canada Pacific Blue Cross Full time**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...
-
Claims Adjuster
3 days ago
Burnaby, British Columbia, Canada Optimum West Insurance Company Inc Full timeJob SummaryThe Claims Adjuster - Property is a key member of our team at Optimum West Insurance Company Inc, responsible for handling property and physical damage automobile claims. This role requires excellent customer service skills, as well as the ability to investigate losses, evaluate coverage, negotiate claims, and settle them within policy...
-
Claims Adjuster
3 days ago
Burnaby, British Columbia, Canada Optimum West Insurance Company Inc Full timeJob SummaryThe Claims Adjuster - Property is a key member of our team at Optimum West Insurance Company Inc, responsible for handling property and physical damage automobile claims. This role requires excellent customer service skills, as well as the ability to investigate losses, evaluate coverage, negotiate claims, and settle them within policy...
-
Claims Adjuster
1 day ago
Burnaby, British Columbia, Canada Optimum West Insurance Company Inc Full timeJob SummaryWe are seeking a highly skilled Claims Adjuster - Casualty & Auto to join our team at Optimum West Insurance Company Inc. The successful candidate will be responsible for handling minor to complex size casualty claims, as well as automobile, accident benefits, and minor property losses.Main ResponsibilitiesCoverage Determination: Investigate and...
-
Claims Adjuster
23 hours ago
Burnaby, British Columbia, Canada Optimum West Insurance Company Inc Full timeJob SummaryWe are seeking a highly skilled Claims Adjuster - Casualty & Auto to join our team at Optimum West Insurance Company Inc. The successful candidate will be responsible for handling minor to complex size casualty claims, as well as automobile, accident benefits, and minor property losses.Main ResponsibilitiesCoverage Determination: Investigate and...
-
Claims Adjuster
2 days ago
Burnaby, British Columbia, Canada Optimum West Insurance Company Inc Full timeJob SummaryOptimum West Insurance Company Inc. is seeking a highly skilled Claims Adjuster - Casualty & Auto to join our team. As a Claims Adjuster - Casualty & Auto, you will be responsible for handling minor to complex size casualty claims, as well as automobile, accident benefits, and minor property losses.Main ResponsibilitiesCoverage Determination:...
-
Claims Adjuster
2 days ago
Burnaby, British Columbia, Canada Optimum West Insurance Company Inc Full timeJob SummaryOptimum West Insurance Company Inc. is seeking a highly skilled Claims Adjuster - Casualty & Auto to join our team. As a Claims Adjuster - Casualty & Auto, you will be responsible for handling minor to complex size casualty claims, as well as automobile, accident benefits, and minor property losses.Main ResponsibilitiesCoverage Determination:...
-
Disability Claims Specialist
1 week ago
Burnaby, Canada Pacific Blue Cross Full time**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...
-
Senior Claims Resolution Expert
3 weeks ago
Burnaby, British Columbia, Canada Crawford & Company Full timePosition Overview We are seeking a Senior General Claims Adjuster to enhance our team. The ideal candidate will be responsible for investigating, assessing, negotiating, and resolving commercial claims through both phone and written communication. This role involves guiding field adjusters on specific assignments and ensuring the precise documentation,...
-
Experienced General Claims Adjuster
3 weeks ago
Burnaby, British Columbia, Canada Crawford & Company Full timePosition Overview We are seeking a Senior General Claims Adjuster to enhance our team. The ideal candidate will be responsible for investigating, assessing, negotiating, and resolving commercial claims through both telephone and written communication. This role involves directing field adjusters on specific assignments and ensuring the precise documentation,...
-
Claims Adjuster
8 hours ago
Burnaby, British Columbia, Canada Optimum West Insurance Company Inc Full timeJob SummaryAt Optimum West Insurance Company Inc, we are seeking a skilled Telephone Adjuster Property to join our team. As a key member of our claims department, you will be responsible for handling minor to moderate size property and physical damage automobile claims.Key Responsibilities:Investigate and evaluate claims to determine coverage and...
-
Claims Adjuster
23 hours ago
Burnaby, British Columbia, Canada Optimum West Insurance Company Inc Full timeJob SummaryAt Optimum West Insurance Company Inc, we are seeking a skilled Telephone Adjuster Property to join our team. As a key member of our claims department, you will be responsible for handling minor to moderate size property and physical damage automobile claims.Key Responsibilities:Investigate and evaluate claims to determine coverage and...
-
Insurance Claims Specialist
1 week ago
Burnaby, British Columbia, Canada All Write Insurance Agencies Ltd. Full timeInsurance Claims RepresentativeWe are seeking a detail-oriented and client-focused Insurance Claims Representative to fill a permanent position at All Write Insurance Agencies Ltd. As an Insurance Claims Representative, you will be responsible for monitoring insurance claims, responding to client inquiries, and providing exceptional customer service.Key...
-
Senior Commercial Claims Specialist
3 weeks ago
Burnaby, British Columbia, Canada Crawford & Company Full timePosition Overview We are seeking a Senior General Claims Adjuster to enhance our team. The ideal candidate will be responsible for investigating, assessing, negotiating, and resolving commercial claims through both telephone communication and written correspondence. This role involves guiding field adjusters on specific assignments and ensuring the...
-
Senior Manager of Insurance
2 months ago
Burnaby, Canada Gateway Casinos & Entertainment Limited Full timeYour RoleThe Senior Manager Insurance/Claims is primarily responsible for investigating, analyzing, resolving and determining the extent of Gateway Casinos’ liability concerning personal, casualty and property loss claims. Also, the Manager negotiates, tracks and manages the Gateway insurance policy portfolio. Additional responsibilities include...
-
Senior Manager of Insurance
2 months ago
Burnaby, Canada Gateway Casinos & Entertainment Limited Full timeYour RoleThe Senior Manager Insurance/Claims is primarily responsible for investigating, analyzing, resolving and determining the extent of Gateway Casinos’ liability concerning personal, casualty and property loss claims. Also, the Manager negotiates, tracks and manages the Gateway insurance policy portfolio. Additional responsibilities include...
-
Disability Claims Adjudicator
5 days ago
Burnaby, British Columbia, Canada Pacific Blue Cross Full timeAbout Pacific Blue CrossPacific Blue Cross is a leading provider of health, dental, life, disability, and travel coverage to individuals and groups in British Columbia. We are committed to keeping healthcare sustainable for all British Columbians.Job SummaryWe are seeking a highly skilled Disability Claims Management Specialist to join our team. As a...
-
Disability Claims Adjudicator
3 days ago
Burnaby, British Columbia, Canada Pacific Blue Cross Full timeAbout Pacific Blue CrossPacific Blue Cross is a leading provider of health, dental, life, disability, and travel coverage to individuals and groups in British Columbia. We are committed to keeping healthcare sustainable for all British Columbians.Job SummaryWe are seeking a highly skilled Disability Claims Management Specialist to join our team. As a...
-
Disability Claims Management Specialist 2
3 weeks ago
Burnaby, Canada Pacific Blue Cross Full time**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...
-
Disability Claims Management Specialist 2
3 months ago
Burnaby, Canada Pacific Blue Cross Full time**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...
