Compliance Analyst - Claims Assurance Services
Alberta Blue Cros
Edmonton
6d ago

FUNCTION :

Claims Assurance Services conducts compliance verification activities of health care providers and plan members to assure compliance with provider agreements, group contracts, policies, procedures, applicable legislation, and Alberta Blue Cross controls.

This position offers the opportunity to work with a team dedicated to accuracy and detail.

The main responsibility of this position is to analyze and report on claims submitted by both health care providers and plan members.

DUTIES AND RESPONSIBILITIES :

  • Complete claims analysis to assure compliance with provider agreements, group contracts, policies, procedures, applicable legislation, and Alberta Blue Cross controls.
  • Prepare working papers, letters and reports.
  • Develop and maintain good relationships with service providers and customers.
  • Follow the team’s policies, procedures, and quality standards.
  • Under the guidance of Team Manager, issue reports on claims and / or monetary adjustments and changes in practice to facilitate compliance.
  • Participate in internal department process reviews and make recommendations for process improvements.
  • Complete special projects, analysis and consultation to meet business requirements.
  • Travel is required approximately once a month to conduct on-site visits within Alberta.
  • A valid Class 5 Driver's License is required.
  • SKILLS AND KNOWLEDGE :

  • In the process of completing or have completed a post-secondary degree preferably in science or business. Related experience may also be considered.
  • Demonstrate strong analytical and logical thinking skills with the ability to solve complex problems.
  • Excellent interpersonal and communication skills.
  • Proven track record of being organized, committed to accuracy, and detailed.
  • Exhibit commitment to teamwork and be willing to learn and adapt to changing priorities.
  • Capacity to work on multiple projects, prioritizes, and meets deadlines.
  • Demonstrate self-direction with a strong sense of responsibility and accountability.
  • Proficient in Microsoft Word and Excel. A working knowledge of Access would be an asset.
  • Experience in the health care benefits industry is desirable, but not essential.
  • Alberta Blue Cross offers a competitive salary and benefits package and the opportunity to work in a challenging team-oriented environment.

    This position will remain open until a suitable candidate is selected. If you have the qualifications we are looking for, please submit your resume and salary expectations to www.ab.bluecross.ca.

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