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Audit Investigator

Posting Date: Aug 3, 2019

Location: Moncton, New Brunswick, CA, E1C 8L3

Company: Medavie Blue Cross

For over 75 years, Medavie Blue Cross has been a leading health and wellness partner for individuals, employers and governments across Canada. We are proud to be a not-for-profit organization dedicated to giving back to the communities where we live and work, and to ensuring our employees thrive in our award-winning, collaborative culture. We are one of Canada’s Most Admired Corporate Cultures and are recognized as a Caring Company, a designation for national leaders in community investment and social responsibility.

Our team of 2,100 professionals work across six provinces. We excel by living our shared values of being caring, accountable, responsible, innovative and community-minded. We’re committed to ensuring the health and wellness of our employees and their families, along with personal and professional growth, through a variety of programs and support at all levels of our organization.

Along with Medavie Health Services, we are part of Medavie — a national health organization with over 6,400 employees. Together, our mission is to improve the wellbeing of Canadians. 

Job Title: Audit Investigator  
Department: Private Business Audit  
Competition: 5118  
Internal/External: Internal/External  
Employment Type: Permanent Full Time  
Location: Moncton  
Salary: Compentitive Salary   
Reports To: Team Leader   
   

 

The Opportunity

 

We currently have an opening for an accountable, self-directed individual to join the Private Business Audit unit of our Audit & Investigations team as Audit Investigator.  As a member of the team, your accountabilities will include, but not be limited to, applying audit and analytical tools and techniques in the review for abnormal claiming patterns among healthcare providers of our company’s drug, hospital, extended-health and dental benefit programs.  In this role, the Auditor will be required to maintain constant and efficient communication with service providers and customers.

 

Key Responsibilities

 

  • Planning, performing, and leading claims audits and other investigative engagements in a manner consistent with audit and fraud examination industry best-practice;
  • Applying query analytics and expert software to profile for indicators of inappropriate claims submissions by healthcare providers;
  • Performing audits of providers and plan members including: pre-audit and post-audit work; determining the most appropriate course of action based on your findings; compiling findings; and completing final case reports in a manner that is presentable to management, law enforcement agencies and/or other regulatory bodies as required;
  • Summarizing findings, recommendations, and corrective actions in written reports;
  • Building, developing and maintaining strong relationships with colleagues and customers, to encourage open dialogue and collaborative commitment to problem solving, continuous improvement, and corporate risk mitigation;
  • Maintaining a commitment to ongoing learning, developing audit skills in line with best-practice, and building a strong foundation in insurance and healthcare industry principles and knowledge; and
  • Leading and assisting in the performance of other unique risk-based projects.

 

Qualifications

 

  • Knowledge of audit principles, practices and methodologies acquired preferably through 1-3+ years of experience in auditing and/or investigative practices;
  • Relevant post-secondary education is required.  A professional designation in fraud detection, auditing or investigative techniques would be considered an asset;
  • Experience in the use of data analytics software (e.g. ACL, Excel, etc.), along with an ability to learn and apply statistical inference and data sampling principles to large data populations;
  • Assertive, with excellent initiative, problem solving and analytical skills;
  • Ability to work well with a team and collaborate both internally and with external stakeholders and management;
  • Ability to articulate thoughts in a clear and concise manner (both verbal and written);
  • Ability to manage multiple competing priorities and tight deadlines;
  • Demonstrated computer skills (including word processing, spreadsheets, flowcharts, etc.);
  • Financial Services experience would be an asset, preferably within the insurance and/or healthcare industry.

 

Core competencies

 

Integrity, Ethics & Professionalism: A high degree of personal integrity, ethics and professionalism is required.

 

Audit Knowledge & Problem-Solving: Demonstrated ability to think ‘outside the box’, apply knowledge and understanding to identify patterns, solve complex problems, and formulate opinions through the application and interpretation of data and other factual information.

 

Independence, Autonomy & Ownership: Demonstrated aptitude to work autonomously, make decisions daily with little supervision, and assume ownership over work assigned.

 

Planning, Coordinating & Multi-Tasking: Exhibit an administrative aptitude toward planning, coordinating and leading multiple engagements at the same time with little direction.

 

Communication, Relationship Building & Partnering: Excellent communication skills, including ability to write persuasively in a clear and concise manner, and to communicate effectively and build strong relationships with senior organizational staff and professionals.

 

Apply Now

 

 

We would like to thank all candidates for expressing interest.  Please note only those selected for interviews will be contacted.

 

Medavie Blue Cross is an equal opportunity employer.

 

We would like to thank all candidates for expressing interest.  Please note only those selected for interviews will be contacted.

Medavie Blue Cross is an equal opportunity employer.


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