Audit Investigator, Medavie Blue Cross; Moncton

Accounting / Finance

 

 

About Medavie Blue Cross

For over 70 years, and across six provinces Medavie Blue Cross has been a leading diversified health services partner for individuals, plan sponsors, plan advisors and governments across Canada. They are proud to be a not-for-profit organization committed to giving back to the communities where they live and work. They support the health and wellness of their employees and their families with various wellness programs and resources to support their personal and professional growth.

They consist of a team of 1,900 colleagues dedicated to collaboration, innovation, customer service, and committed to work-life balance, community involvement and career development which is why Medavie Blue Cross is recognized as a Top 100 Employer and one of Canada's 10 Most Admired Corporate Cultures.

About the role

We currently have an opening for an accountable, self-directed individual with a positive attitude to join our Government Business Audit Team as a Provider Auditor.

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 Provider Auditor will be required to maintain constant and efficient communication with 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 provider audits 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 Audit 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,
  • 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 preferred. A professional designation in fraud detection, auditing or investigative techniques (e.g. CPA, CIA, CFE, etc.) would be considered an asset;
  • Experienced 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 would be ideal;
  • 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.

To Apply

Apply Now!

As the successful candidate, you will enjoy working at a fast pace; managing timelines and a substantial workload; documentation and follow-up items; and exploring ways to improve processes and maximize efficiencies. You are a self-starter who enjoys new challenges, working well independently as well as in a team environment.

Canadian Citizenship - Please indicate in your application the reason you are entitled to work in Canada: Canadian citizenship, permanent resident status or work permit.

Reliability screening will be required.

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