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Claims Auditor II-TELUS Health

TELUS

TELUS

Toronto, ON, Canada · Toronto, ON, Canada
Posted on Thursday, January 25, 2024

Claims Auditor II-TELUS Health

Location:

Toronto, ON, CA, M5J 2V5

Req ID: 38651
Jobs by Category: Health
Job Function: Health Solutions
Status: Full Time
Schedule: Regular

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 Full-Time position
  • Working virtually supported by our TELUS Health Work Styles program
  • Flexible work schedule: Monday to Friday between 8am and 5pm
  • Competitive salary


Responsibilities:

  • Conduct various types of audits including desk, on-site, compounds, carrier requested audits etc.
  • Respond to complex carrier requests (follow-up and answer carrier questions)
  • Generate and compile data from multiple sources including providers, cardholders, physicians and dentists
  • Assist as required with daily reports and complete investigation and reports on audit findings
  • Present audit findings on a quarterly basis internally and/or to clients as required
  • Maintain complete and accurate documentation of all audit related information, reports and conversations
  • Manage multiple assignments at one time and provide back up support to other auditors
  • Provide basic technical support to insurance companies, providers, help desk and other teams in Client Services
  • Contribute to achieving team objectives and delivery on service level commitments
  • Team player who collaborates within and/or across internal business units to develop and execute on audit initiatives/projects
  • Identify and work on process improvements

Qualifications

  • Must be able to travel within Canada as required
  • Must possess a valid drivers license
  • Knowledge of business flows in claims management and submission
  • Knowledge of Microsoft (MS) Office and network systems
  • Solid knowledge of pharmacy and/or audit practices
  • Ability to manage confidential information and protect privacy
  • Performs well under pressure and demonstrates effective time management skills
  • Excellent collaboration skills
  • Ability to manage multiple tasks at the same time, and being responsive to change in process/reports in response to the dynamic nature of audit
  • Ability to communicate bilingually (English and French) and effectively with pharmacies to obtain or exchange information and/or resolve issues
  • Conflict resolution skills required when dealing with recovery of money from pharmacy and education around submission requirements


Required Professional Accreditation or Certification

  • Post-secondary diploma/certification
  • University or technical degree in a relevant field
  • Minimum of 3 years of experience in a retail pharmacy

Salary Range: $46,000-$68,000
Performance Bonus or Sales Incentive Plan: 5%

Actual total compensation will be determined based on factors such as knowledge, skills, performance, experience and location. Additionally, TELUS offers rewarding benefits, which may vary per job function, such as:

  • Comprehensive total rewards package highlighting competitive salary and bonus structures, minimum 3 weeks of vacation, and flexible benefits plan to meet the needs of you and your family
  • Flexibility to work in-office, virtually or a combination of both
  • Generous company matched pension and share purchase programs
  • Opportunity to give back to communities in which we work, live and serve
  • Career growth and learning & development opportunities to develop your skills
  • And much more …

Please note that the compensation shown in the job posting is effective January 2023 and may be subject to change in 2024.

A bit about us

We’re a people-focused, customer-first, purpose-driven team who works together every day to innovate and do good. We improve lives through our technology solutions and foster a culture of innovation that empowers team members to solve complex problems and create remarkable human outcomes in a digital world.

You’ll find our engaging, high-performance culture personally fulfilling, professionally challenging, and financially rewarding. We’re committed to diversity and equitable access to employment opportunities based on ability. Your unique contributions and talents will be valued and respected here. When you join our team, you’re helping us make the future friendly.

TELUS Health is an IT leader in Canada that focuses on the health sector. Our mission is to improve the way information is being used along the continuum of care to better the health of citizens in Canada and in selected countries.

Disclaimer: In accordance with the TELUS Health Solutions Data Center Security Policy, as a condition of employment, all team members whose job functions require they work at a Data Center and/or have access to detailed knowledge of technology related to client service delivery, are subject to a Personnel Security Screening conducted through the Government of Canada.

The health and safety of our team, customers and communities is paramount to TELUS. Accordingly, we require anyone joining our TELUS Health Care Centres to be fully vaccinated for COVID-19.

Note for Quebec candidates: if knowledge of English is required for this position, it is because the team member will be asked, on a regular basis, to interact in English with external or internal parties or to use English applications or software as part of their tasks.

Health

We’re looking for clinicians, programmers, product developers, sales and marketing people, customer support, and everyone in between. If you have a penchant for turning information into better health outcomes, then we want you to help us develop, implement and manage the most innovative healthcare solutions possible.

We are honoured to be recognized

21,166
Physicians using TELUS Health electronic medical records

6,300
Pharmacies using our pharmacy solutions

140 million+
Health claims processed using TELUS Health solutions

Accessibility

TELUS is proud to foster an inclusive culture that embraces diversity. We are committed to fair employment practices and all qualified applicants will receive consideration for employment.

We offer accommodation for applicants with disabilities, as required, during the recruitment process.

Claims Auditor II-TELUS Health

Location:

Toronto, ON, CA, M5J 2V5

Req ID: 38651
Jobs by Category: Health
Job Function: Health Solutions
Status: Full Time
Schedule: Regular

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 Full-Time position
  • Working virtually supported by our TELUS Health Work Styles program
  • Flexible work schedule: Monday to Friday between 8am and 5pm
  • Competitive salary


Responsibilities:

  • Conduct various types of audits including desk, on-site, compounds, carrier requested audits etc.
  • Respond to complex carrier requests (follow-up and answer carrier questions)
  • Generate and compile data from multiple sources including providers, cardholders, physicians and dentists
  • Assist as required with daily reports and complete investigation and reports on audit findings
  • Present audit findings on a quarterly basis internally and/or to clients as required
  • Maintain complete and accurate documentation of all audit related information, reports and conversations
  • Manage multiple assignments at one time and provide back up support to other auditors
  • Provide basic technical support to insurance companies, providers, help desk and other teams in Client Services
  • Contribute to achieving team objectives and delivery on service level commitments
  • Team player who collaborates within and/or across internal business units to develop and execute on audit initiatives/projects
  • Identify and work on process improvements

Qualifications

  • Must be able to travel within Canada as required
  • Must possess a valid drivers license
  • Knowledge of business flows in claims management and submission
  • Knowledge of Microsoft (MS) Office and network systems
  • Solid knowledge of pharmacy and/or audit practices
  • Ability to manage confidential information and protect privacy
  • Performs well under pressure and demonstrates effective time management skills
  • Excellent collaboration skills
  • Ability to manage multiple tasks at the same time, and being responsive to change in process/reports in response to the dynamic nature of audit
  • Ability to communicate bilingually (English and French) and effectively with pharmacies to obtain or exchange information and/or resolve issues
  • Conflict resolution skills required when dealing with recovery of money from pharmacy and education around submission requirements


Required Professional Accreditation or Certification

  • Post-secondary diploma/certification
  • University or technical degree in a relevant field
  • Minimum of 3 years of experience in a retail pharmacy

Salary Range: $46,000-$68,000
Performance Bonus or Sales Incentive Plan: 5%

Actual total compensation will be determined based on factors such as knowledge, skills, performance, experience and location. Additionally, TELUS offers rewarding benefits, which may vary per job function, such as:

  • Comprehensive total rewards package highlighting competitive salary and bonus structures, minimum 3 weeks of vacation, and flexible benefits plan to meet the needs of you and your family
  • Flexibility to work in-office, virtually or a combination of both
  • Generous company matched pension and share purchase programs
  • Opportunity to give back to communities in which we work, live and serve
  • Career growth and learning & development opportunities to develop your skills
  • And much more …

Please note that the compensation shown in the job posting is effective January 2023 and may be subject to change in 2024.

A bit about us

We’re a people-focused, customer-first, purpose-driven team who works together every day to innovate and do good. We improve lives through our technology solutions and foster a culture of innovation that empowers team members to solve complex problems and create remarkable human outcomes in a digital world.

You’ll find our engaging, high-performance culture personally fulfilling, professionally challenging, and financially rewarding. We’re committed to diversity and equitable access to employment opportunities based on ability. Your unique contributions and talents will be valued and respected here. When you join our team, you’re helping us make the future friendly.

TELUS Health is an IT leader in Canada that focuses on the health sector. Our mission is to improve the way information is being used along the continuum of care to better the health of citizens in Canada and in selected countries.

Disclaimer: In accordance with the TELUS Health Solutions Data Center Security Policy, as a condition of employment, all team members whose job functions require they work at a Data Center and/or have access to detailed knowledge of technology related to client service delivery, are subject to a Personnel Security Screening conducted through the Government of Canada.

The health and safety of our team, customers and communities is paramount to TELUS. Accordingly, we require anyone joining our TELUS Health Care Centres to be fully vaccinated for COVID-19.

Note for Quebec candidates: if knowledge of English is required for this position, it is because the team member will be asked, on a regular basis, to interact in English with external or internal parties or to use English applications or software as part of their tasks.

Health

We’re looking for clinicians, programmers, product developers, sales and marketing people, customer support, and everyone in between. If you have a penchant for turning information into better health outcomes, then we want you to help us develop, implement and manage the most innovative healthcare solutions possible.

We are honoured to be recognized

21,166
Physicians using TELUS Health electronic medical records

6,300
Pharmacies using our pharmacy solutions

140 million+
Health claims processed using TELUS Health solutions

Accessibility

TELUS is proud to foster an inclusive culture that embraces diversity. We are committed to fair employment practices and all qualified applicants will receive consideration for employment.

We offer accommodation for applicants with disabilities, as required, during the recruitment process.

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 Full-Time position
  • Working virtually supported by our TELUS Health Work Styles program
  • Flexible work schedule: Monday to Friday between 8am and 5pm
  • Competitive salary


Responsibilities:

  • Conduct various types of audits including desk, on-site, compounds, carrier requested audits etc.
  • Respond to complex carrier requests (follow-up and answer carrier questions)
  • Generate and compile data from multiple sources including providers, cardholders, physicians and dentists
  • Assist as required with daily reports and complete investigation and reports on audit findings
  • Present audit findings on a quarterly basis internally and/or to clients as required
  • Maintain complete and accurate documentation of all audit related information, reports and conversations
  • Manage multiple assignments at one time and provide back up support to other auditors
  • Provide basic technical support to insurance companies, providers, help desk and other teams in Client Services
  • Contribute to achieving team objectives and delivery on service level commitments
  • Team player who collaborates within and/or across internal business units to develop and execute on audit initiatives/projects
  • Identify and work on process improvements

Qualifications

  • Must be able to travel within Canada as required
  • Must possess a valid drivers license
  • Knowledge of business flows in claims management and submission
  • Knowledge of Microsoft (MS) Office and network systems
  • Solid knowledge of pharmacy and/or audit practices
  • Ability to manage confidential information and protect privacy
  • Performs well under pressure and demonstrates effective time management skills
  • Excellent collaboration skills
  • Ability to manage multiple tasks at the same time, and being responsive to change in process/reports in response to the dynamic nature of audit
  • Ability to communicate bilingually (English and French) and effectively with pharmacies to obtain or exchange information and/or resolve issues
  • Conflict resolution skills required when dealing with recovery of money from pharmacy and education around submission requirements


Required Professional Accreditation or Certification

  • Post-secondary diploma/certification
  • University or technical degree in a relevant field
  • Minimum of 3 years of experience in a retail pharmacy