Manager - Claims Audit and Investigation Services

6 days 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 and investigations of health care providers and plan members to assure compliance with provider agreements, group contract, policies, procedures, applicable legislation, and Alberta Blue Cross® controls.

**WHAT YOU WILL DO**:

- Act as the primary resource for your assigned team, monitor investigations, and ensure investigation and reporting meet all required standards.
- Proactively address internal and external clients’ needs that are escalated to you and help your team to prioritize work items to meet client service standards.
- Responsible for the management of the day-to-day activities of team members including workload management, investigative direction, coaching and mentoring.
- Establish and continuously enhance best practices guidelines for the successful delivery of the investigations. This will serve as the framework for the professional development of team members.
- Maintain a positive, collaborative team which inspires high productivity and encourages the generation of new ideas and enhanced work processes.
- Recommend and implement changes to processes, policies, and procedures to optimize service delivery and enhance productivity.
- Recruit, train, mentor, and coach team members, with an end goal of retaining a work force of the highest quality for both the team and our organization.
- Actively participate in the planning and implementation of Claims Audit and Investigation Services operational initiatives.

**WHAT YOU WILL HAVE**:

- Post-secondary education preferred in police studies, criminal justice, law, commerce, or related studies.
- Comprehensive understanding of major case management principles
- Ability to employ advanced investigative techniques.
- 10 + years’ experience in investigations and/or auditing.
- 5+ years’ leadership experience.
- Exceptional communication skills, including written and verbal. Experienced in investigation interviewing.
- Commitment to quality customer service is required for success in this position. This includes the ability to establish and maintain effective working relationships with both internal and external customers.
- Ability to work well independently as part of a virtual team, with a strong sense of responsibility and accountability.
- Experience in the health care benefits industry is desirable.

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.

  • Investigator - Claims Audit & Investigation Services

    2 weeks 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...

  • Remote Claims Adjuster: Investigate and Resolve

    3 weeks ago

    Burnaby, Toronto, Montreal, Calgary, Vancouver, Edmonton, Old Toronto, Ottawa, Mississauga, Quebec, Winnipeg, Halifax, Saskatoon, Hamilton, Victoria, Surrey, London, Halton Hills, Regina, Markham, Brampton, Vaughan, Kelowna, Laval, Southwestern Ontario, R, Canada Sedgwick Claims Management Services Ltd Full time

    A leading claims management company in Burnaby is seeking a Claims Adjuster to investigate and manage insurance claims. This role requires excellent analytical and interpersonal skills, with the ability to negotiate settlements effectively. Candidates should possess post-secondary education and be either licensed or on the path to obtaining a license. The...

  • Claims Investigator

    2 weeks ago

    Edmonton, Canada Peace Hills Insurance Full time

    We currently have a full-time position available for a Special Investigator in our Claims Department. Reporting to the Vice President, Claims, the successful applicant will be focused on integrating the principles and techniques of criminal investigations into the claims process in identifying and reviewing potentially fraudulent claims. **Primary Duties...

  • Claims Adjuster Trainee

    4 days ago

    Edmonton, Canada Coast Claims Insurance Full time

    **Company Overview** Coast Claims Insurance Services is a premier firm in the insurance adjusting industry, as we expand our exceptional team in Edmonton. We are currently seeking to fill the role of Claims Adjuster Trainee. This exceptional opportunity is designed to accelerate your career growth, providing you with the chance to collaborate closely with a...

  • Property Claims Adjuster

    2 weeks ago

    Edmonton, Canada Coast Claims Insurance Full time

    **Company Overview** Coast Claims Insurance Services has been a premier firm in the insurance adjusting industry since 1970. Over the years, we've attracted top-notch talent and expanded throughout BC, Alberta, Ontario, and the Northwest Territories, becoming Canada's fourth-largest firm. **Why working for us**: At Coast, we're dedicated to cultivating a...

  • Health, Safety

    2 weeks ago

    Edmonton, Canada Greater Edmonton Taxi Service Full time

    **About Us** tappCONNECT Inc. provides a supportive and progressive work environment for our employees that will not only challenge but also encourage new ideas and solutions. We focus on collaborative efforts and always take the time to listen and learn from our team members. **About You** You have a great customer service experience with a keen eye for...

  • Senior Adjuster Executive

    4 weeks ago

    Calgary, Toronto, Montreal, Vancouver, Edmonton, Old Toronto, Ottawa, Mississauga, Quebec, Winnipeg, Halifax, Saskatoon, Burnaby, Hamilton, Victoria, Surrey, Halton Hills, London, Regina, Markham, Brampton, Vaughan, Kelowna, Laval, Southwestern Ontario, R, Canada Sedgwick Claims Management Services Ltd Full time

    A leading claims management services company is seeking an Adjuster General Executive in Calgary. This role involves investigating complex claims against insurance companies, negotiating settlements, and preparing detailed reports. Ideal candidates will have a Bachelor's degree, relevant experience, and strong communication skills. Join a diverse and...

  • Pharmacy Claims Auditor

    6 days 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...

  • Claims Examiner

    2 weeks ago

    Edmonton, Canada Alberta Motor Association Full time

    Are you passionate about helping others? Do you like doing something different every day? Then you’re just the person we’re looking for! This role supports and mentors Claims Adjusters on complex claims while identifying trends to ensure compliance. You’ll be an expert in the technical aspects of the claim process. WHAT MOVES YOU - Not only are you an...

  • Claims Representative

    4 days ago

    Edmonton, Canada Scandinavian Building Services Full time

    Scandinavian Building Services has been a Canadian leader in retail and commercial cleaning for the last 60 years. Starting as a small family owned and operated business in Edmonton Alberta in 1982 to offering full service janitorial and building maintenance across Canada today. We attribute our success to staying true to our core values of Service,...