Investigation Services Unit Analyst - Winnipeg, Canada - Manitoba Blue Cross

Manitoba Blue Cross

Verified Company

Winnipeg, Canada

2 weeks ago

Posted by:

Sophia Lee

beBee Recruiter

Description

Manitoba Blue Cross was born out of a desire to protect our fellow Manitobans during life's most unexpected and sometimes challenging moments.

This remains our driving force today, and fuels our ongoing commitment to providing superior health and wellness benefits that are delivered with compassion and excellence in service.

As an independent and not for profit organization for over 40 years, we provide health, dental, employee assistance, disability, travel and life coverage to over half a million Manitobans.

At Manitoba Blue Cross, our people are the key to our success Consider becoming part of our team of professionals committed to providing exceptional customer service.

Join us as we serve our neighbours to support and strengthen our community.

JOB TITLE INVESTIGATION SERVICES UNIT ANALYST (Term)

REPORTS TO Supervisor, Investigation Services Unit

JOB SUMMARY

The Investigation Services Unit Analyst employs statistical and mathematical methodologies to identify trends and provide insight to the business unit.

The incumbent is responsible for analyzing and conducting investigations of client transaction activity to identify patterns or irregularities that will be further investigated by the Investigation Services Unit Auditors.

DUTIES AND RESPONSIBILITIES

Performs various claims analyses to ensure compliance with provider agreements, group contracts, policies/procedures, applicable legislation and Manitoba Blue Cross controls.
Coordinates and assists with analyzing internal profiling reports to identify trends and patterns.
Prepares reports and recommendations for the Investigation Services Unit Auditors and Supervisor.
Supports the Auditors with audits as required.
Participates in internal department process reviews and develops recommendations for process improvements.
Stays informed on advances and techniques in Healthcare Fraud processes including competitors, associations, etc.
Develops and maintains good relationships with service providers and customers.
Willingly shares expertise and resources to contribute to best practices for collecting data, investigations and researching resolutions.
Participates in corporate and departmental projects.
Performs other related duties as assigned.

SKILLS AND QUALIFICATIONS

Dedicated to the principles of exceptional service; committed to responding to, anticipating and addressing customer needs, for both internal and external customers.
Postsecondary degree, certificate, or diploma preferably in business, science or related field. Equivalent combination of education and 2 to 5 years' experience may be considered.
Ability to gather information from multiple resources and systems, analyze and reach decision in a timely and effective manner.
Proven sound judgment and decisionmaking skills in order to accurately identify unusual activity and patterns.
Exceptional interpersonal and communication skills (verbal and written) with ability to deal with all levels within the organization in a team environment, service providers and clients.
Selfmotivated, with exceptional organizational skills and a proven record of managing and prioritizing multiple tasks within varied and dynamic timelines on an ongoing basis with a strong attention to detail.
Intuitive ability to see past the numbers to identify anomalous circumstances, trends and events.
Ability to work independently as well as in a team setting.
Membership to a recognized fraud association would be an asset, or willingness to obtain membership would be encouraged.
Completion of or capable of completing industry education programs entailing a selfdirected study and the writing of graded examinations. Specific programs include but are not limited to LOMA ( ACS ) and CEBS. Enrollment in, and completion of, such courses, as well as programs of professional development, will be encouraged.

We offer competitive salary, modified benefits, hybrid work arrangements, a flex work schedule, and a health and wellness program with an on-site fitness centre.

We are committed to creating a rewarding environment to foster learning and development for our staff.

If you are interested in joining our team, please forward a resume and cover letter, indicating salary expectations, by March 6, 2023.

All qualified applicants will receive consideration for employment without regard to race, national or ethnic origin, colour, religion, age, sex, sexual orientation, gender identity or expression, marital status, family status, genetic characteristics, disability and conviction for an offence for which a pardon has been granted or in respect of which a record suspension has been ordered.

Only those being considered for the selection process will be contacted.