Senior Claims Auditor-TH
TELUS
Senior Claims Auditor-TH
Toronto, ON, CA, M5J 2V5
Description
If you are passionate about investigating insurance fraud and abuse and would like to pursue an excellent career opportunity with one of the largest Canadian providers.
Join our team
We are a team of high performing individuals who together make TELUS Health the largest Canadian supplier with a complete and integrated drug, dental and extended health claims transmission, adjudication and administration solution.
The Claims Auditor is responsible for conducting claims audits on behalf of our clients to validate claims submitted by providers and ensure compliance with the terms and conditions of the provider agreement.
Position Overview:
- Permanent position (37.5 hours per week)
- Working virtually supported by our TELUS Health Work Styles program
- Flexible work schedule: Monday to Friday between 8am and 5pm
- Competitive salary and benefits including group insurance program (drug, extended health, dental, vision and life) and participation in the Employee Share Ownership Plan
Responsibilities:
- Analyze provider transactional profiles to uncover anomalous behavior
- Analyze cases and develop investigation plans
- Identify emerging fraud trends and refine algorithms using data analysis tools
- Evaluate complaints related to suspicious transactions
- Assist with specific investigations and other special projects
- Transpose and structure the customer's business needs and support the project team in the creation of rules, plans, messages, service codes, etc. as required.
- Work on the design and/or interpretation of test scenarios for new rules created in collaboration with various internal teams.
- Act as an expert to support the customer test team (UAT) in the project phase to resolve anomalies.
- Analyze, implement and continuously improve certain joint processes between the customer and TELUS
- Carry out ad hoc analyses for any aspect requiring decision-making and guidance
- Work closely with operational teams to support them in the development and maintenance of multi-service solutions (documentation, training).
- Prepare and draft documentation for internal and/or external customers
- Work with responsible teams to address customer issues, find solutions and improvements
By applying to this role, you understand and agree that your information will be shared with the TELUS Group of Companies’ Talent Acquisition team(s) and/or any leader(s) who will be part of the selection process.
Qualifications
Required Experience:
- Minimum of 3 years of fraud investigation experience or equivalent experience in the review, interpretation and analysis of claims to identify potential areas of insurance fraud or abuse in the area of extended health and dental insurance
- University or technical degree in a relevant field
- Certified Fraud Examiners title is preferred
Skills and Abilities:
- Leadership in working with customers at all levels
- Excellent communication skills, both oral and written, in French and English
- Ability to work in a matrix environment
- Excellent problem solving skills
- Strong analytical skills and the ability to quickly understand complex business concepts
- Ability to manage multiple priorities
- Strong Microsoft Office skills - Word, Excel, PowerPoint
Senior Claims Auditor-TH
Toronto, ON, CA, M5J 2V5
Description
If you are passionate about investigating insurance fraud and abuse and would like to pursue an excellent career opportunity with one of the largest Canadian providers.
Join our team
We are a team of high performing individuals who together make TELUS Health the largest Canadian supplier with a complete and integrated drug, dental and extended health claims transmission, adjudication and administration solution.
The Claims Auditor is responsible for conducting claims audits on behalf of our clients to validate claims submitted by providers and ensure compliance with the terms and conditions of the provider agreement.
Position Overview:
- Permanent position (37.5 hours per week)
- Working virtually supported by our TELUS Health Work Styles program
- Flexible work schedule: Monday to Friday between 8am and 5pm
- Competitive salary and benefits including group insurance program (drug, extended health, dental, vision and life) and participation in the Employee Share Ownership Plan
Responsibilities:
- Analyze provider transactional profiles to uncover anomalous behavior
- Analyze cases and develop investigation plans
- Identify emerging fraud trends and refine algorithms using data analysis tools
- Evaluate complaints related to suspicious transactions
- Assist with specific investigations and other special projects
- Transpose and structure the customer's business needs and support the project team in the creation of rules, plans, messages, service codes, etc. as required.
- Work on the design and/or interpretation of test scenarios for new rules created in collaboration with various internal teams.
- Act as an expert to support the customer test team (UAT) in the project phase to resolve anomalies.
- Analyze, implement and continuously improve certain joint processes between the customer and TELUS
- Carry out ad hoc analyses for any aspect requiring decision-making and guidance
- Work closely with operational teams to support them in the development and maintenance of multi-service solutions (documentation, training).
- Prepare and draft documentation for internal and/or external customers
- Work with responsible teams to address customer issues, find solutions and improvements
By applying to this role, you understand and agree that your information will be shared with the TELUS Group of Companies’ Talent Acquisition team(s) and/or any leader(s) who will be part of the selection process.
Qualifications
Required Experience:
- Minimum of 3 years of fraud investigation experience or equivalent experience in the review, interpretation and analysis of claims to identify potential areas of insurance fraud or abuse in the area of extended health and dental insurance
- University or technical degree in a relevant field
- Certified Fraud Examiners title is preferred
Skills and Abilities:
- Leadership in working with customers at all levels
- Excellent communication skills, both oral and written, in French and English
- Ability to work in a matrix environment
- Excellent problem solving skills
- Strong analytical skills and the ability to quickly understand complex business concepts
- Ability to manage multiple priorities
- Strong Microsoft Office skills - Word, Excel, PowerPoint
Description
If you are passionate about investigating insurance fraud and abuse and would like to pursue an excellent career opportunity with one of the largest Canadian providers.
Join our team
We are a team of high performing individuals who together make TELUS Health the largest Canadian supplier with a complete and integrated drug, dental and extended health claims transmission, adjudication and administration solution.
The Claims Auditor is responsible for conducting claims audits on behalf of our clients to validate claims submitted by providers and ensure compliance with the terms and conditions of the provider agreement.
Position Overview:
- Permanent position (37.5 hours per week)
- Working virtually supported by our TELUS Health Work Styles program
- Flexible work schedule: Monday to Friday between 8am and 5pm
- Competitive salary and benefits including group insurance program (drug, extended health, dental, vision and life) and participation in the Employee Share Ownership Plan
Responsibilities:
- Analyze provider transactional profiles to uncover anomalous behavior
- Analyze cases and develop investigation plans
- Identify emerging fraud trends and refine algorithms using data analysis tools
- Evaluate complaints related to suspicious transactions
- Assist with specific investigations and other special projects
- Transpose and structure the customer's business needs and support the project team in the creation of rules, plans, messages, service codes, etc. as required.
- Work on the design and/or interpretation of test scenarios for new rules created in collaboration with various internal teams.
- Act as an expert to support the customer test team (UAT) in the project phase to resolve anomalies.
- Analyze, implement and continuously improve certain joint processes between the customer and TELUS
- Carry out ad hoc analyses for any aspect requiring decision-making and guidance
- Work closely with operational teams to support them in the development and maintenance of multi-service solutions (documentation, training).
- Prepare and draft documentation for internal and/or external customers
- Work with responsible teams to address customer issues, find solutions and improvements
By applying to this role, you understand and agree that your information will be shared with the TELUS Group of Companies’ Talent Acquisition team(s) and/or any leader(s) who will be part of the selection process.
Qualifications
Required Experience:
- Minimum of 3 years of fraud investigation experience or equivalent experience in the review, interpretation and analysis of claims to identify potential areas of insurance fraud or abuse in the area of extended health and dental insurance
- University or technical degree in a relevant field
- Certified Fraud Examiners title is preferred
Skills and Abilities:
- Leadership in working with customers at all levels
- Excellent communication skills, both oral and written, in French and English
- Ability to work in a matrix environment
- Excellent problem solving skills
- Strong analytical skills and the ability to quickly understand complex business concepts
- Ability to manage multiple priorities
- Strong Microsoft Office skills - Word, Excel, PowerPoint