Senior Claims Fraud Investigator - Burnaby, Canada - Pacific Blue Cross

    Pacific Blue Cross
    Pacific Blue Cross Burnaby, Canada

    2 weeks ago

    Default job background
    Permanent, Full time
    Description

    Senior Claims Fraud Investigator

    Requisition # Job LocationCanada-British Columbia-Burnaby Job StreamHealth Insurance Job TypePermanent, Full-Time Salary/Rate$82, $95,000.00 / Year Number of Positions1 Start Date of Employment ASAP Posting Date15-Apr-2024 Travel RequiredNot Required Educational RequirementsCollege Diploma Languages RequiredEnglish Job Description

    About Pacific Blue Cross

    Pacific Blue Cross (PBC) has been British Columbia's leading benefits provider for over 80 years. We are an independent, not-for-profit society with strong roots in BC's health care system. We provide health, dental, life, disability, and travel coverage to 1 in 3 British Columbians through employee group plans and individual plans.

    We are fueled by a commitment to keep health care sustainable for all British Columbians. Through our PBC Health Foundation, we fund projects that improve health outcomes directly related to mental health and wellbeing as well as the prevention and/or management of chronic disease. We are interested in finding people who want to make a difference and who are looking to grow their career with us.

    Perks

  • Work-life balance with flexible working hours of 7.5 hours per day, Monday to Friday (i.e., 37.5 hours per week).
  • Paid vacation starts at 4 weeks per year, and increases with years of service.
  • Hybrid work environment (i.e., a combination of work from office and work from home days).
  • Generous benefits, including extended health, dental, and life insurance; depending on the plan that you choose, these benefit premiums can be 100% paid by PBC.
  • Company pension contributions after 1 year of service.
  • Education allowance to expand your knowledge and develop your skills.
  • Onsite gym, cafeteria, and access to virtual doctors/counsellors 24/7 via our Employee Family Assistance Program

    • About the Position

  • We are searching for a permanent Senior Claims Fraud Investigator to join our Fraud Investigations team.
  • The starting salary will be determined based on a combination of skills, education, and experience. The salary range is $82,000 – $95,000 per year.

    • If you're looking to take on a role that leads and participates in investigations of suspected claims fraud and insurance abuse, we want to hear from you. This is a great career opportunity with a local not-for-profit health insurance provider where you would work with key internal stakeholders, vendors and clients.

    Your skills in leading investigations, providing mentorship, analyzing and evaluating cases, preparing reports will help Pacific Blue Cross provide sustainable healthcare.

    We offer an attractive compensation and benefits package and work-life balance. Our workplace culture values health and wellness, diversity and equality, continuing education, environmental sustainability and giving back to the community.

    This role is currently working from home 3 days a week and 2 days a week at our head office in Burnaby, BC. Apply this week if you would like to take on this role.

    Key Ways This Position Makes An Impact

    The Senior Claims Fraud Investigator will conduct routine to complex investigations primarily focused on suspected claims fraud and insurance abuse.

    This role analyzes and evaluated cases in order to develop investigative plans for execution.

    In this role, you would gather information and evidentiary material to support findings that follows the evidence chain of custody procedures.

    You would prepare comprehensive reports for approval by management that include evidence findings, results, and recommended recovery actions and amounts.

    In this role, you would participate in and lead investigative related projects that represent significant loss exposure.

    The Senior Claims Fraud Investigator prepares file documentation for forwarding to regulatory bodies and law enforcement.

    Key Experiences You Bring To This Role

  • Bachelor's degree in Criminology, Business, or an equivalent discipline.
  • 5 – 8 years of related experience in a fraud investigation position, or equivalent experience in reviewing, interpreting, and analyzing claims to identify potential areas of fraudulent or insurance abuse claims.
  • Effectively communicate with various levels of management, external parties, law enforcement, synthesize complex information, making it relevant, understandable, and actionable for internal and external stakeholders.
  • Strong verbal/written communication and presentation skills, including the ability to communicate with both technical and business teams.
  • Certified Fraud Examiner designation, or equivalent.
  • Knowledge of administrative law procedures.
  • Advanced Excel skills (i.e., complex data manipulation, statistical analysis, filtering and advanced use of formulas and functions).
  • Demonstrate strong analytical and logical thinking and sound judgement skills with the ability to solve complex problems.

    • It's considered an asset if you have:

  • Knowledge of the Health Professions Act (B.C.).
  • Knowledge of SQL and ACL (running and pairing reports to identify patterns).
  • Experience negotiating investigation settlements.