Bilingual Claims Verification Analyst

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