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Senior Life and Disability Claims and Audit Consultant

Posting Date: Jan 12, 2021

Location: CA Moncton, New Brunswick, CA, E1C 0M3 Dartmouth, Nova Scotia, CA, B3J 3C6 CA

Company: Medavie Blue Cross

Blue Cross Life Insurance Company of Canada is a federally licensed company that distributes its products through a network of Blue Cross Plans.  The Company specializes in life and disability income protection products that supplement and enhance the portfolio of health products distributed by its Shareholder Blue Cross Plans.

Job Title: Senior Life and Disability Claims and Audit Consultant  
Department: Blue Cross Life   
Competition: 11498  
Internal/External: Internal and External  
Employment Type: Permanent, Full Time  
Location: Moncton, Montreal, Dartmouth or Etobicoke   
Salary: Competitive Compensation  
Reports To: Director  
Closing Date: January 25  

The Opportunity

You will be responsible for administering and updating a claims audit program that will allow Blue Cross Life to perform oversight of the regional Blue Cross plans’ claims operations and to fulfill the regulatory requirements of federal financial institutions.You will be responsible for conducting annual claims audits for all life and disability products sold under Blue Cross Life’ s license. You will also be developing and communicating Blue Cross Life claim policies to the regional Blue Cross plans across Canada and monitoring adherence to various corporate policies. Finally, you will provide recommendations and expert advice to Blue Cross Life and the regional Blue Cross plans on various claim related matters.


Key Responsibilities

  • Planning, performing, and leading operational claims audits;  conducting reviews of the regional Blue Cross plans’ claims processes, policies and procedures; documenting, evaluating, and testing controls to determine their existence, adequacy, efficiency and effectiveness at managing claims and adherence to Blue Cross Life’s Best Claims Practices and other corporate policies;
  • Preparing presentations and reports for management and executives at Blue Cross Life and the regional Blue Cross plans detailing audit findings, highlighting strengths and opportunities, and suggesting initiatives for improvement based on observations and trends identified in claims audits;
  • Monitoring the regional Blue Cross plans responses to audits and action plans;
  • Developing and communicating Blue Cross Life claims best practices and policies to the regional Blue Cross plans as well as monitoring their implementation;
  • Developing relationships with and providing expertise, support and guidance on claims related matters to the regional Blue Cross plans;
  • Reviewing and approving claims that are over the regional Blue Cross plans’ authority limits and/over the limits defined in the various reinsurance treaties;
  • Acting as a subject matter expert for various systems initiatives lead by Blue Cross Life or the regional Blue Cross plans;
  • Producing various quarterly, biennial and annual claims reports as required by external auditors, Blue Cross Life Corporate Compliance and Operational Risk;
  • Assisting in the performance of other functions and projects as assigned by the Director of Claims and Medical Underwriting; and
  • The incumbent must be willing to travel regularly.



Education: The ideal candidate will have a bachelor’s degree with a focus in a health or financial services related discipline. The equivalent in education and experience will be considered.


Work Experience: Minimum of 7 years of experience managing complex disability claims. Minimum of 2-3 years of experience with life and/or CI claims management and auditing experience, and experience managing a claims team or operations are strong assets.


Other Qualifications:

  • Excellent verbal and written communication skills.
  • High degree of self-confidence and the ability to work independently.
  • Insurance industry knowledge (LOMA, CEBS, ICA, etc.)


Computer Skills: Experience working with the Microsoft Office Suite.


Language Skills: Bilingualism in English and French is required.


Core competencies

Knowledge: Knows how businesses work, knowledgeable in current and possible future policies, practices, trends, and information affecting his/her business and organization, knows the competition, is aware of how strategies and tactics work in the marketplace.


Analytical Thinking: Uses rigorous logic and methods to solve difficult problems with effective solutions, probes all fruitful sources for answers; can see hidden problems; is excellent at honest analysis; looks beyond the obvious and doesn’t stop at the first answers.


Communication Skills: Communicates clearly and confidently verbally and in writing to a variety of audiences. Demonstrates the ability to tailor information and delivery to suit the nature of the material, audience and situation. Is effective both inside and outside the organization, on both cool data and hot and controversial topics.


Customer Orientation: Relates well to all kinds of people, up, down, and sideways, inside and outside the organization; builds appropriate rapport; builds constructive and effective relationships; uses diplomacy and tact; can diffuse even high-tension situations comfortably.


Execution and Organizational Skills: Can effectively cope with change; can decide and act without having the total picture; can comfortably handle risk and uncertainty. Spends his/her time and the time of others on what's important;; can quickly sense what will help or hinder accomplishing a goal; eliminates roadblocks.


Team Work: Can quickly find common ground and solve problems for the good of all; can represent his/her own interests and yet be fair to other groups; can solve problems with peers with a minimum of noise; easily gains trust and support of peers; encourages collaboration; can be candid with peers.


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

Blue Cross Life is an equal opportunity employer.

Job Segment: Audit, Underwriter, Medical, Claims, Finance, Insurance, Healthcare